HisS 








Class 1?U1 

Book JQ. 

Gop\iight>S° 

COPYRIGHT DEPOSIT. 



SELECTED ADDRESSES 



JAMES TYSON 



SELECTED ADDRESSES 



On Subjects Relating to 
Education, Biography, Travel, Etc, 



BY 

JAMES TYSON, M. D., LL. D., 

PROFESSOR OF MEDICINE, EMERITUS, UNIVERSITY OF PENNSYLVANIA 



PHILADELPHIA 

P. BLAKISTON'S SON & CO 

1012 WALNUT STREET 



a 



x*< 






Copyright, 1914, by James Tyson 



DEC 21 1914 

THB.MAPIiE.PBE8S.TOKK.PA 

©CI.A391053 
kp, 



DEDICATED 

TO THE NUMEROUS PHYSICIANS WHO FROM TIME TO TIME 

HAVE PATIENTLY SAT UNDER MY INSTRUCTION DURING 

A LONG CAREER AS A TEACHER OF MEDICINE 



PREFACE 

If asked why I republish these addresses I confess 
to some embarrassment in seeking justification for 
again imposing on the patience of those who may 
have read them and trespassing on the time of those 
who may read them for the first time. A truth- 
ful answer would, I think, be a desire to revive the 
memory of the pleasant occasions on which they were 
delivered. But I confess also that some expressions 
of approval at the time have kept alive the embers of 
a pride of authorship which were always ready to be 
fanned into a more active flame by a suitable stimu- 
lus. Such a stimulus has come to me with the in- 
creased leisure allowed by my retirement from the ab- 
sorbing duties of my professorship. I feel, too, that 
I am sending "a repeated message'' to many of my 
old students which some will be glad to receive. 



Vll 



CONTENTS 

Page 

I. Requirements of a Modern College Education, 1884. 3 

II. Three Short Addresses, 1891, 1892, 1893 29 

III. The Office of the College and the Duty of the Graduate, 

1906 49 

IV. Some Considerations Preliminary to the Study of Medi- 

cine, 1889 63 

V. Valedictory Address to the Graduating Class in Medi- 

cine ; and Dentistry, University of Pennsylvania, 1891 83 

VI. The General Practitioner, 1898 \ . . . 97 

VII. Hospital Organization, 1904 115 

VIII. The Trained Nurse, 1907 137 

IX. Memoir of Albert Holmes Smith, M.D., 1887 .... 149 

X. Memoir of William Pepper, M.D., 1901 163 

XI. Address on Presentation of Portrait of Dr. William W. 

Gerhard to the College of Physicians, 1897 .... 193 

XII. Response to the Toast of our " Foreign Guests" at the 
Annual Dinner of the British Medical Association 

at its Meeting in Portsmouth, England, August, 1899 199 

XIII. Physician's Holiday at Karlsbad, 1901 207 

XIV. Physician's Holiday at Vichy, 1903 227 

XV. Physician's Holiday in the Engadine, 1909 249 

XVI. Address of the President on the Dedication of the New 

Hall of the College of Physicians of Philadelphia, 1909 259 

XVII. Review of the Progress of Medicine during the last Half 

Century, 1863-1913 311 

XVIII. L'Envoi 361 



IX 



I 

THE REQUIREMENTS OF A MODERN COL- 
LEGE EDUCATION— 1884 



THE REQUIREMENTS OF A MODERN 
COLLEGE EDUCATION. 1 

"Incedis per ignes suppositos cineri doloso" 

These are the words of warning written me by one 
whom Haverford has known as student, teacher, and 
distinguished alumnus, and I as classmate and valued 
friend of more than five and twenty years, on learning 
that I would speak to-day of college education. 
Doubtless, it would have been well for me and for 
you had this warning been heeded. But like the 
moth irresistibly drawn to the flame which destroys 
it, I seem impelled to this topic of burning importance, 
although conscious that I shall fall far short of its 
adequate treatment. Certain it is, too, that I cannot 
claim excuse because the subject has lacked considera- 
tion at the hands of others well qualified to discuss it. 
For it is as little likely to be disputed as to be com- 
plained of that college education has received more and 
closer attention in the past quarter of a century than 
during any like period in its history. Notwithstand- 
ing this, there remain decided differences in the views 
of those whose knowledge, training, and experience 
qualify them to speak with authority. It has been 
well said by one 2 who possesses all the essentials of 
authority named, that a great obstacle in the way of a 
correct conclusion is "the common belief of most 
educated men in the indispensableness of the subjects 
in which they were themselves instructed." To this 
should be added the belief of many in the uselessness 

Oration delivered at the Twenty-eighth Annual Meeting of the 
Alumni Association of Haverford College, tenth month 4th, 1884. 

2 Professor Eliot, paper read before the members of Johns Hopkins 
University, February 22d, 1884. 

3 



4 SELECTED ADDRESSES 

of that in which they have not been themselves in- 
structed. It must be admitted that we are all the 
victims of prejudice, and I will not attempt to decide 
which of the two categories contains the larger number, 
although I believe that it will be generally conceded 
that the latter includes at least as many as the former. 

What has been the general result of the discussion 
up to the present time is not difficult to indicate. In 
general it may be said that the attention given to the 
study of English and English literature has been in- 
creased, that to natural sciences and modern languages 
has been greatly increased, and that to mathematics 
and the classics diminished. The statement with 
regard to the last two requires, however, some modi- 
fication, at least so far as the older colleges are con- 
cerned, indeed, all those existing twenty-five years 
ago. Opportunities even ampler than those afforded 
at that time are now given to those who desire them, 
but these studies are made more largely elective. 
Indeed, it should be said that one of the most impor- 
tant results of the discussion has been that the system 
of electing studies is more general. Further enlarged 
elective opportunities are offered in the Semitic and 
Indo-Iranian languages, more particularly at Harvard 
College. 

In a number of younger colleges which have arisen 
within this period, particularly in the West and South, 
the secondary importance attached to the classics is 
seen in the fact that they, and especially the Greek, 
are no longer required for admission, even of the 
candidate for the B. A. degree. With regard to some 
of these colleges, at least, there is sufficient cause to 
believe that the reason for this omission lies in the 
fact that were these languages required the colleges 
would cease to exist. They are, in truth, colleges in 
name but not in fact. 



COLLEGE EDUCATION 5 

A further effect of these changes has been to modify 
the title of degrees conferred. It has appeared to 
most governing bodies that the degree of Bachelor 
of Arts should no longer be conferred upon those 
students in whose courses of study the classics are 
altogether substituted by a larger proportion of scien- 
tific or technical studies. To such the degree of 
Bachelor of Science or Bachelor of Philosophy is given, 
or Bachelor of Civil or Mining Engineering where 
technical studies preparatory to professional life have 
been pursued. Some institutions, as Swarthmore 
College, have provided a degree of Bachelor of Letters 
for those who pursue especially the study of modern 
languages and literature, including English. It must 
be admitted that the number of these degrees has 
increased to an unfortunate extent. They are so 
numerous that one is often puzzled to interpret them, 
and sometimes the same initials are used to indicate 
different degrees. Within a few days I have seen a 
diploma which conferred the degree of Bachelor of 
English, the letters for which are of course the same as 
those of Bachelor of Engineering. It need scarcely 
be said that reference is here intended to degrees in 
course. It is a healthful sign that the higher, or 
masters' and doctors' degrees are being gradually 
hedged in by wholesome restrictions which make them 
at once fewer and of greater significance. They are, 
however, still far too numerous, and too indiscrimi- 
nately conferred. 

By common consent the degree of Bachelor of Arts 
has heretofore been regarded as the mark of a liberal 
education, and since the institution of additional 
degrees, as implying higher attainments than most of 
these. For this degree, in most colleges, the study of 
Latin and Greek is required during a part of a four 
years' course; but in some Greek has been omitted 



6 SELECTED ADDRESSES 






from the requirements, and at Harvard College, by a 
recent action, while Greek is still required for admis- 
sion, its continuance is made elective. Where Greek 
is omitted from the requirements, French and German 
are sometimes substituted. 

It is needless to say that the value of these various 
degrees must depend largely upon the practices of 
the institution conferring them, and it is of course not 
impossible that the man possessing a degree in Science 
or Literature may be more liberally educated than one 
holding an A. B. degree. Granted, however, that a 
man may have a liberal education without ever having 
studied Latin and Greek, no one will deny that he is 
not more liberally educated who has had, in addition 
to any curriculum which a college faculty may con- 
sider as meeting the requirements, the further advan- 
tage of whatever there is useful in the study of the 
classics. So, too, unquestionably, the modern scholar 
who has added to the requirements of the older cur- 
riculum in which the Latin and Greek claimed a larger 
share of attention, a more intimate knowledge of 
English literature, history, the modern languages 
with natural and political science, is certainly more 
liberally educated than he who possesses the former 
only. It is plain then that there are liberal educations 
and more liberal educations, but since the A. B. degree 
has heretofore implied that its possessor has devoted 
considerable attention to Latin and Greek, and it 
still seems desirable that such person should have a 
distinctive title, there can be none more appropriate 
than this time honored one. And if pains be taken to 
exact from him who covets the A. B. degree such 
training as the growth of knowledge in modern times 
demands, in addition to the classics, it can scarcely 
happen that the man untaught in Latin and Greek 
will have a more liberal education than he who has 



COLLEGE EDUCATION 7 

been instructed in these languages. I would so add 
to the requirements for the A. B. degree as to make it 
retain the pre-eminence it has always held. I would 
make it mean more rather than less. 

The question, therefore, resolves itself into this: 
Given in a boy's life a certain amount of time to be 
devoted to college education, how shall it be most 
profitably spent? From the somewhat indifferent 
standpoint of one outside of a college faculty directly 
concerned in such instruction, and at the same time 
in a position to watch its results, it appears to me that, 
ignoring for the time being the question as to what 
constitutes a liberal education, the answer must vary 
with the intended career of the boy and the time at 
his disposal. It has already been said that the develop- 
ment of the natural sciences, the growth of English 
literature, and the demands of modern civilization, 
justly require that more time shall be devoted to 
English and other modern languages, to natural and 
political science. Now, since it is impossible to give 
to them the increased time and attention without 
taking from that formerly devoted to the classics, 
one of two things is necessary, either more time must 
be given, or that formerly devoted to Latin and Greek 
must be curtailed. 

The idea of extending the college course has not 
claimed much attention, and perhaps at present would 
not be favorably entertained by many. At the same 
time, much, if not all the difficulty in the way of a 
truly liberal education would be obviated by such a 
course, as I think will presently appear. Considering 
it from the standpoint of a curtailment of the classics, 
the end would be partially accomplished by increas- 
ing the requirements for admission to college. This 
has been done in some instances, but the general 
uniformity in these requirements, as adopted by the 



8 SELECTED ADDRESSES 

best colleges throughout the country, not by the 
horde of low-grade schools and so-called universities 
which have sprung up in the South and West since 
the Rebellion, would go to show that the proper 
amount is about reached. But in so far as it is to be 
met by a shortening of the time formerly devoted to 
Latin and Greek, it can be regulated by the proposed 
occupation of the student. If it be said in reply 
to this, that many boys enter college without a definite 
idea as to their future career, I say this need not be 
if the attention of the boy, his parents or guardians, 
be directed to the matter as it should be. And if it 
so happen that there are such, they must submit to 
an election by others whose experience has qualified 
them to determine the best average course of study, 
independent of a preparation for a future career. 
Such course I believe to be the ordinary curriculum 
for the A. B. degree, as carried out by the better 
class of colleges. 

Given, however, a boy of sixteen to eighteen years 
of age, and who has four years to spend at college, 
how shall this be most profitably occupied in ac- 
cordance with the idea suggested? In the first 
place, shall his preparatory education be different, 
according as he may be intended for one of the so- 
called liberal professions, or for engineering, or 
practical chemistry, for business or political life? 
Here at once we are met with the question of lan- 
guages. All agree that the boy shall be familiar with 
arithmetic and English grammar, be able to spell 
correctly, to frame a fair English sentence, have a 
general knowledge of geography and history, of alge- 
bra and plane geometry. What languages then shall 
he prepare? Now, while I deem it not unreasonable 
to expect a boy to have at least a general idea of what 
his future career is to be when he enters college, it 



COLLEGE EDUCATION 9 

cannot be expected that he should always know much 
earlier than this. Should this happen to be the case, 
all the better, and the modifications in the course of 
study presently to be suggested may begin at such 
time. Granted, however, that this is not so, the ob- 
ject must be to secure a preliminary training which 
may be a common point of departure whence may di- 
verge the different courses of study adapted to the 
various occupations of modern life. Indeed, my own 
observation would go to show that whatever the future 
career of the student, it is most profitable for the 
entire collegiate class to pursue the same studies dur- 
ing the first or freshman year, which is, after all, 
largely a year of molding and pruning, of training 
and development. It is the opinion of college pro- 
fessors of large experience with whom I have con- 
versed, that the developmental changes produced in 
the student are far more marked during this year of 
his college life than during any other. So surprising 
is it, indeed, that it is sometimes scarcely possible to 
recognize in the polished and pliant sophomore the 
crude and uncouth freshman of the year previous. 

I hold that in such a preliminary training, the lan- 
guages, of which it is reasonable to demand at least 
two, should be those which aid him most in the study 
of his own, and prepare him for the study of such others 
as may subsequently appear desirable. That the 
Latin is such a language seems to be generally con- 
ceded. I have never met a single person possessing 
even moderate acquirements in Latin, together with 
a knowledge of one or more modern languages, who 
was not willing to admit that his study, not only of 
French, Spanish, and Italian, but also of English, 
had been greatly facilitated by such knowledge. 
In view of this fact, and this other that the ablest 
opponents of what may be called the older system of 



10 SELECTED ADDRESSES 

college education are almost all willing that Latin 
should retain its place in the curricula, I deem it 
unnecessary to occupy your time with any more ex- 
tended attempt to show that this language should be 
one of those pursued preparatory to college. I will 
simply add that it has occurred to me within the past 
year to know a boy who had had all the advantages 
of an excellent English school, under a master who 
enjoyed an especial reputation for excellence in teach- 
ing English grammar. The lad had been subjected 
to the usual drill, had been over and over again the 
rules of grammar, and had made some progress in 
the study of German, but seemed to get no idea of 
parsing and the construction of sentences until he 
had become well advanced in his Latin studies. 

Much more difficult is it to select the second 
language. But taking the physician's method of 
diagnosis by exclusion, I quickly eliminate the French, 
which is so easily acquired, taxes the mind, relatively, 
so little, in its acquirement, and is as yet so little 
needed in the e very-day of life. By which I do not 
wish to be understood as placing a low estimate 
on French as an accomplishment. On the other 
hand, it should form a part of every liberal educa- 
tion, and in certain occupations it is indispensable 
for the highest success. I am simply referring now 
to the time at which it may be most advantageously 
studied. Personal illustrations, I know, are not in 
the best taste, but I cannot refrain from saying that 
I never spent more than one quarter in the systematic 
study of French, and that was after I left college. 
Yet, thanks to the Latin which Haverford gave me, 
and this one quarter's instruction, I can read fairly 
well the French literature of my own profession, 
and I fell certain that in three months of systematic 
study I could acquire a facility which it has taken me 



COLLEGE EDUCATION 11 

years to acquire in German, in which, too, my read- 
ing is altogether technical. 

The German, on the other hand, with its splendid 
literature, its practical availability, and the discipline 
which the greater difficulty in its acquirement exer- 
cises, contests strongly with the Greek the second 
place in the preparatory education. Like Greek, 
it is a more difficult language than either the Latin or 
French. It, too, has words corresponding to the Greek 
particles in their delicate shades of meaning and signi- 
ficance, when correctly translated. So that, although 
less difficult than Greek, its disciplinary effect is 
similar. And while I think it makes very little dif- 
ference which of these languages is studied first if 
the other is to be afterward acquired, I am inclined 
to believe, on account of the possible practical avail- 
ability of the German to one whose college course 
may be accidentally interfered with, that an elective 
permitting Latin and German, or Latin and German 
with a smaller amount of Greek than is usually de- 
manded, would meet the language requirement. In 
such case, if the B. A. degree is sought, it would, 
of course, be necessary, in accordance with the views 
already expressed, to prolong the study of Greek 
further into the course than is now done, or until 
what is deemed a satisfactory amount is accomplished. 

Such a condition of admission to college, it ap- 
pears to me, would meet the requirements of any 
special course of study intended to be adapted to the 
student's future. This preliminary education being 
secured, we are ready to indicate the course to be 
followed, according to the career selected. Is the 
boy destined to be a civil engineer? Then must 
mathematics, physics, and drawing, together with 
the technical studies proper, be the pivotal centre 
around which everything must move. And since 



12 SELECTED ADDRESSES 

the people of existing nations are the sources whence 
his knowledge, both present and future, is to come, 
and especially through the medium of French, Ger- 
man, and English writings, the languages in which 
these are found should be especially studied, and so 
thoroughly mastered by the future engineer that they 
may be made available in his every-day business 
life. Whether with all the time that can be allotted 
to these languages such a mastery is possible, is 
doubtful, but such a start may, at least, be acquired 
as will materially facilitate their continued study, 
which will be stimulated also by the actual require- 
ment of the occupation or the ambition of the man. 
Of equal importance with the languages, if not para- 
mount, to the civil engineer, is a knowledge of chemis- 
try, mineralogy, and geology. And to the mining 
engineer they are, of course, paramount. A man 
thus educated has a technical education, and in ac- 
quiring it has earned the right to a technical degree. 
He may be said also to have a liberal education, but 
less liberal than one who, although divested of the 
technical training, possesses, in addition to the 
branches of a liberal education above named, a knowl- 
edge of the classics and of their literature, of modern 
literature, and of the natural sciences. And if it 
should happen that the engineer has had the time and 
opportunity to acquire such education, in addition 
to the technical qualifications which best fit him for 
his buisness, will he be in any way inferior as an engi- 
neer? There are no theoretical grounds on which one 
would expect a negative answer, while in point of 
fact it is a matter of experience in America as well as 
Germany that the best civil engineers are those who 
have had a thorough classical training. 

Is the boy to be a practical chemist or geologist? 
Here, too, the primary and fundamental branches of 



COLLEGE EDUCATION 



13 



study after the preliminary training are easily in- 
dicated — physics, chemistry, mineralogy, geology. 
Here, too, the modern languages are vastly useful, 
and after these the natural sciences, especially bot- 
any, and to the geologist, palaeontology. But the 
advantage of the classical training to such students 
as determined by actual experiment are set forth in 
the celebrated Berlin Report. By a decree of the 
Government in December, 1870, the students of the 
Realschule or Scientific Schools of the first class were 
admitted to the University of Berlin on a par with 
those of the Gymnasia or colleges. 1 At the end of ten 
years the Philosophical Faculty reported the results 
of their experience as to the effect of the arrange- 
ment, and as a part of the report we have from the 
Professor of Chemistry the statement "that students 
from the Scientific Schools cannot, in this branch of 
study (chemistry), be placed on the same plane with 

1 That a correct conception may be obtained of the studies and 
time devoted to them in the Prussian Realschule of the first class, as 
compared with the German Gymnasia, I append a table containing 
the studies pursued in each and the number of hours allotted to each 
study per week. 

General Plan of Studies of the Prussian Gymnasium 



VI. 



V. IV. III. II. 



Religion 

German 

Latin 

Greek 

French 

History and Geography 

Mathematics 

Physics 

Natural History 

Drawing 

Writing 

Total number of hours in each week 



3 

2 
10 



3 

2 

10 

3 
2 
3 

2 
2 
3 



2 
2 
10 
6 
2 
3 
3 



2S 



30 



30 



2 
2 
10 
6 
2 
3 
3 



2 
2 
10 
6 
2 
3 
4 
1 



30 



30 



14 



SELECTED ADDRESSES 



the students of the Gymnasia/' while, according to 
the unanimous verdict of experienced teachers in 
the departments of mathematics and the natural 
sciences, graduates of the Realschule are almost 



General Plan of Studies of the Prussian Realschule of the First Rank, 



VI. V. IV. 



III. 



II. 



Religion 

German 

Latin 

French 

English 

Geography and History 

Physical and Natural Science 

Mathematics 

Writing 

Drawing 

Total number of hours in each week 



30 



31 



32 



32 



32 



32 



No account is taken in the above plans of the hours given to 
singing and gymnastics, or to Hebrew in the Gymnasium, the time 
so devoted falling either wholly or in part outside of the regular 
school hours. I and II, and generally III, represent two years 
study each, the others represent single years. It will be observed 
that in the Realschule, Greek is altogether omitted, while the 
time devoted to Latin is reduced nearly one-half; the twenty-six 
hours thus gained, with eleven hours additional, being devoted 
to English and to increase the time already given to German, 
French, mathematics, and the physical and natural sciences. 

The German boy enters the Gymnasium and Realschule at 
nine, and leaves it at eighteen. The Gymnasium, which is usually 
compared with the American College, is not, therefore, strictly 
comparable to it, since the average age of admission here is at 
least fifteen, and many boys do not enter college until eighteen 
or older. What is known as the Philosophical Faculty of the 
German Universities, as distinguished from the Faculties of 
Theology, of Law, and of Medicine, is rather comparable to the. 
last two years of the American College of the first class, including 
both its Faculty of Arts and Faculty of Science. The question 
of the division of the German Philosophical Faculty is one which 



COLLEGE EDUCATION 15 

without exception overtaken in the later semesters 
by students from the Gymnasia, however much they 
may excel them in the same branches in the first 
semester. 1 And although my friend, Professor James, 
of the University of Pennsylvania, claims that the 
conclusions drawn from this report are not justified, 
as my object at present is only to show that the 
classical training would be a good thing for the student 
of science if he could have it in addition to the modern 
education, I do not think he will accuse me of making 
an unwarranted use of it. Further, it is to be re- 
membered that the curricula of the Realschule in 
Germany contain at least as much of Latin as the 
average American curriculum for the B. A. degree. 

Our student will be a physician, and he will be the 
very best that can be made. Here I will say the 

has for some time agitated the mind of the German Government 
as well as the academic circles immediately connected with the 
instruction, and is discussed in the inaugural address of Dr. 
Hoffman, the Professor of Chemistry, on assuming the Rector- 
ship of the University of Berlin, on October 15th, 1880 — an 
address much quoted, which discusses, too, the question as to 
whether the graduates of the Realschule shall be admitted to the 
Universities under the same conditions as those of the Gymnasia. 
This division of the Philosophical Faculty, would resolve it into 
two faculties, of which one would include the natural and physical 
sciences and mathematics, the other, philosophy, philology, 
history, and political science. Another mode of division would 
divide the Philosophical Faculty into three — one for philology, 
history, and philosophy; one for mathematics and the natural 
sciences, and one for political science. 

This division is generally opposed in Germany and Austria, 
and has, as yet, only taken place in the University of Tubingen 
and the new University of Strassburg, although in the University 
of Wurzburg and that of Munich the Philosophical Faculty is 
divided into two sections. At Strassburg each section has its 
separate dean, but at Wurzburg both have one dean, who is taken 
from each by turn. 

1 Dr. Hoffman's address, p. 31. English translation by Ginn, 
Heath & Co., Boston, 1883. 



16 SELECTED ADDRESSES 

Latin is indispensable, a certain amount of Greek also, 
while the value of a thorough classical training can 
scarcely be overestimated. No one needs to have 
so well trained a mind as the doctor, for no one has 
such difficult, and at the same time such important 
problems to solve or such shifting will-o'-the-wisp-like 
data. To my mind the fact that the articles of the 
materia medica have still Latin names, that pre- 
scriptions are written in Latin, and that the Latin is 
still the language of polyglot nations to indicate 
anatomical parts and diseased processes, is a small 
reason why the student of medicine should be well 
drilled in Latin and Greek. It is one of the best 
balance wheels to his reasoning. 

I have never known a man with a thorough Greek 
and Latin training to become other than a scientific 
physician. And it is of such unspeakable advantage 
to him in the study of the collateral sciences, all of 
which seem indispensable to the cultivated physician — 
physics, chemistry, botany, biology, and even miner- 
alogy and geology — all must be his. What labor of 
dictionary hunting is he saved in his early as well as 
later reading! Indeed, so rapidly are new words 
coined in medical science, and the sciences collateral 
to it, that no dictionary can keep pace with them. 
All of these come from the Latin and Greek, and 
are as plain to the good classical scholar as if he had 
coined them himself. And I happen to know that 
medical students sometimes depend exclusively upon 
their Latin and Greek lexicons instead of getting a 
medical dictionary. But to the doctor, French and 
German, and especially German, are equally indis- 
pensable, at least so far as an ability to read them is 
concerned, and he must acquire them sometime in the 
course of his education, professional or preparatory, 
if he would be a physician of the first rank. Now, 



COLLEGE EDUCATION 17 

having acquired all my knowledge of these languages — 
which although not exhaustive is sufficient to enable 
me to make almost daily use of them — after leaving col- 
lege, with the Haverford training of my day in Latin 
and Greek, I may be pardoned for believing that it is 
sufficient if they be taken up in the Junior year in 
place of the Latin and Greek, which, with sufficient 
requirement for admission, should be concluded by 
that time by all except those who expect to become 
teachers of languages or philologists. 

But while the possession of the foregoing attain- 
ments, in addition to a thorough professional training 
and devotion to his profession, may be all that is 
necessary to enable a physician to treat disease as 
successfully as it can be treated, yet nothing con- 
tributes more to the essentials which go to make a 
successful doctor than the refined ease which grows 
out of a thorough and comprehensive knowledge of 
English literature and of history, and which is further 
contributed to by the advantages of travel and social 
intercourse. 

So that in the case of the physician there really 
seems no other way than to lengthen the college cur- 
riculum; for it appears that he ought to have every- 
thing which goes to make up a liberal education. 
But, alas, I am sorry to say he still often has least. 

I believe I may say, too, without fear of contradic- 
tion, that all that I have said of the educational re- 
quirements of the doctor, outside of his technical 
training, is equally true of the teacher, the dignity and 
importance of whose calling, I hold, is second to none. 

The law demands less of its students, outside of the 
technical education, then does medicine. The natural 
sciences do not come so close to the lawj^er as to the 
doctor, but a training in them cannot but develop 
acuteness of observation and the skill in debate 



18 SELECTED ADDRESSES 

which he is so often called upon to exercise. The 
fountain head of law was Rome, and the oratorical 
power which contributes so much to the strength of 
the lawyer has some of its finest illustrations in the 
Greek and Roman orators, who are best studied in 
the original. History and literature are pre-emi- 
nently the domain whence the lawyer acquires much 
that makes him effective and useful, while political 
economy and questions of finance and government 
are closely collateral subjects, which become of 
paramount importance if he would enter upon a 
political career. I have the authority of Charles 
Francis Adams for saying what my own more limited 
observation has led me to conclude, that the law makes 
less demand upon modern languages for its resources 
than any profession or scientific study, so that it 
would seem that for the lawyer the best preliminary 
training is the older college course, modified, as it 
now is, by the addition of history, literature, and 
natural and political science. Whether the incal- 
culable advantage of the modern languages in the 
diplomatic service, which is so largely recruited from 
lawyers, is sufficiently important to require them 
from all law students, I am not prepared to say. 

The ministry, as it is commonly called, has held a 
peculiar position in its relations to liberal education. 
While it has been claimed, on the one hand, that not 
only the Latin and Greek, but also the Hebrew and 
Sanscrit, are the peculiar field of study whence is to 
be obtained all that is potent to make the clergy- 
man efficient and useful — and we find our best scholars 
in these languages among them — yet the most stir- 
ring and abiding teachings have come from those 
who were illiterate. At the same time, there are 
probably few who will contend that the effective- 
ness of the illiterate preacher might not have been 



COLLEGE EDUCATION 19 

increased by a broader culture. And it seems to me 
that the minister of the future must have a broader 
culture still than is furnished by his Latin, Greek, 
or Hebrew, his philosophy, history, and literature. 
Hereafter the natural sciences must claim his atten- 
tion equally with Biblical and linguistic studies if 
he will continue to be our respected guide in religion 
and morals. Biology, anatomy of the lower animals 
and of man, must claim a large share of his attention. 
Provision for such studies is sadly deficient in the 
schools especially set apart for the teaching of the- 
ology. Neither in the Divinity School connected 
with Harvard University, nor at Yale College, do I 
find such. On the other hand, in the Academic 
department of the College of New Jersey, at Prince- 
ton, I find most liberal arrangements of this kind. 

In my judgment, even more than the physician, 
should the preacher be broadly educated. He should 
be linguist, naturalist, physicist, well read in litera- 
ture, expert in debate — indeed, should know all things 
well. He, indeed, ought to have a liberal education 
in its broadest sense. And yet, perhaps, more often 
than physicians are clergymen found one-sided in their 
training. 

While it must be admitted that it is neither possible 
nor necessary in all cases to insist upon a college 
education as a prerequisite to success in mercantile 
life, and while there may still be some who have not 
had the advantages of such training, who may dis- 
claim against it as useless and even disadvantageous 
to the man of business, I believe that most will agree 
with me that where a liberal education is possible it 
is at least no drawback to success. If we seek any 
special line of study which may be peculiarly suitable 
in the preparation for such a career, it must be ad- 
mitted that the modern languages will probably be 



20 SELECTED ADDRESSES 

more useful than the dead, and that accounting and 
political science, rather than philosophy, literature, 
and history, will best serve the future business man. 
At the same time there can be no more effectual rest 
for a brain wearied with business cares than the 
fields of natural science and of literature. And I 
am quite sure there would be fewer business failures 
on the one hand and fewer shattered minds on the 
other, if men of business had some scientific hobby 
to which to turn in moments of leisure. It is an in- 
teresting fact in connection with the recent assemblage 
of scientists in Philadelphia, that so many of our 
English guests were alike conspicuous as scientists 
and business men. While our own country furnishes 
a few instances of the same kind, they are by no 
means as numerous as they should be for the interests 
of science or business. 

Such, in my opinion, is the common sense of college 
education. Since it is impossible to compass in the 
four years of an ordinary curriculum the knowledge 
accumulated during the many centuries of the world's 
existence, and since a limitation has become necessary, 
the basis of selection naturally becomes the future 
career of the student. That such a career, for its 
highest success, requires different degrees in a liberal 
education, is evident, while it is plain also that in 
certain professions and occupations the most liberal 
education is more important than in others. It 
would seem that this is the conclusion to which any 
one must come who looks at both sides of the great 
question. 

With a decided partiality toward the classical 
culture, and a preference that my own son should 
pursue a collegiate course, in which the study not 
only of Latin, but of Greek also, precedes that of the 
modern languages, feeling confident that if provi- 



COLLEGE EDUCATION 21 

sion is made for the latter in the Junior year, as much 
and more will be accomplished than if they were 
studied earlier, to the exclusion of the classics, I can- 
not fail to see the force of certain arguments brought 
forward by the advocates of the newer education, 
and I have endeavored to mold my curriculum in 
accordance with them. But I know, too, that it is 
quite possible to add to the older curriculum much 
that is demanded by the growth of knowledge, with- 
out materially weakening its best features; and thus 
there may be added not only the modern languages, 
but also an amount of English literature and of the 
natural sciences which will decidedly broaden the 
resulting culture. 

I was not aware, until I looked into the matter 
closely, how nearly the present course at Haverford 
accords with this view, which I deem the natural re- 
sult of a fair and unprejudiced examination of the 
subject. In my time, the Latin and Greek ran 
throughout the entire four years, and we were taught 
no modern languages whatever. We were taught 
chemistry well, better, as I afterward learned, than 
at any contemporary college with which I could com- 
pare it. And I found that at the medical school 
which I entered, I had no need to study chemistry. 
Haverford had taught me as much, although I am 
happy to say that the chemistry at that same medical 
school is a very different thing to-day from what it 
was then. We were well instructed at Haverford in 
the physics of the day; were taught some geology, 
but very little botany and no zoology. Now, I note 
by the catalogue, and one can always be sure that 
what is laid down in Haverford's catalogue is carried 
out, that the required Latin and Greek terminate with 
the Sophomore year, and yet as much of both is read 
as in my time, while the corresponding hours in the 



22 SELECTED ADDRESSES 

Junior and Senior year may be devoted to French, 
German, Anglo-Saxon, and even Hebrew. In addi- 
tion, there are found botany, zoology, anatomy, physi- 
ology and hygiene, with extended opportunities in 
English literature. The department of philosophy, 
always full, including psychology, metaphysics, moral 
philosophy, natural and revealed religion and logic, 
is in no way curtailed. The additional hours required 
for the important subjects of a modern education, 
are also partly furnished by making elective certain 
mathematical studies, which, in our day, were required 
throughout the entire course. That the mathemat- 
ical course of that day, which included practical as- 
tronomy, was a complete one, I infer from the fact 
that including electives, it contains no more to-day 
than then. Valuable hours are thus secured, while 
sufficient time is still left to secure the training and 
discipline which are the raison d'etre of the higher 
mathematics to those who will not use them practi- 
cally in after life. 

It is now nearly five and twenty years since the 
Class of 1860, of which I was a member, was graduated 
from Haverford. In those days no stately Barclay 
Hall greeted the stranger entering our grounds from 
the east. No Gothic Alumni Hall bounded the west- 
ern view. There was only plain, yellow-coated 
Founders' Hall, which with the Observatory and 
Gymnasium constituted our College. The old col- 
lecting-room, which witnessed all our exercises, in- 
cluding those of junior exhibition and commence- 
ment, is now, I believe, the dining-room; the school 
room in which all but seniors were then required to 
sit at desks during a part of the day, and an hour in 
the evening, is a class room, and the remainder of the 
old building has been apparently put to altogether 
new uses, with which I am not familiar. 



COLLEGE EDUCATION 23 

The railroad which wound along our eastern bound- 
ary is removed, and this change has a confusing effect 
upon the old student returning after long absence. 
But Haverford, though changed and improved, is 
still, I am glad to say, much the same. There are 
the same societies — the Loganian, the Athenaeum, 
and Everett — and the Dorian Cricket Club, of which I 
was a member, seems to be the Club of to-day. The 
sharp crack of the cricket bat rings as of old through 
the clear October air, the same old trees look down 
upon us, and the same shaded walks and bowers 
invite us to linger. The same restfulness pervades, 
the same homelike comfort exists, the same welcome 
awaits her returning sons and revives in them the 
slumbering longing for the old days forever past. 

The Class of 1860 was a lusty one. Numbering 
twelve, it was the largest graduated up to its date, 
and has not been often exceeded in this respect since. 
I have no doubt the united stature of the men was 
greater than that of any other twelve who were ever 
graduated, so many tall ones were there among us. 
The class was one of strong individuality, mental as 
well as physical. Who who knew him will ever for- 
get Lindley M. Clark? His slightly bent but still 
tall and impressive figure, his deliberate movement, 
his gentleness and modesty, united with great firm- 
ness and strength of purpose, are easily recalled. 
His far-seeing discernment and interest in public 
affairs bespoke for him, had his life been spared, a 
position in the councils of the nation. But his was a 
physique illy adapted to the confinement of the close 
student's life, and symptoms of ill health even while 
among us, were doubtless the earliest manifestations 
of disease which culminated in a fatal consumption, 
little more than a year after he left College. 

A contrast to Clark, in many respects, although 



24 SELECTED ADDRESSES 

always associated with him in my mind, was Cyrus 
Lindley. Quick in movement and cheerful in tem- 
perament, he was the champion walker, and with his 
friend, the sunny and lamented Dick Chase, of " '61," 
left little unexplored within many miles of Haverford. 
The first of our class to marry, as teacher, farmer, 
preacher, he still lives, reveling, as he writes me, in 
the memory of those blissful Haverford associations. 

No less conspicuous was Silas A. Underhill. As tall 
as Clark, and more erect, I mostly see him towering 
above all others in the fray of the shinny ground, or 
resting watchfully on his long shinny, awaiting the 
ball which was sure to go home with his well-directed 
blow. Enlisting as a private soldier, and continuing 
such from principle throughout the entire Rebellion, 
he survived its vicissitudes and dangers, and practices 
law in the Brooklyn courts, having thus far escaped 
the bonds of matrimony. 

William B. Corbit was characterized while at 
College by his enthusiastic devotion to the classics, 
especially Greek. He studied medicine, but the 
languages, ancient and modern, were ever his favorite 
study, and what was at first a pastime subsequently 
became an occupation; for in 1874 he entered the serv- 
ice of the Government, assisting the late Dr. Wood- 
ward in the preparation of the Medical History of the 
War, in which work his accurate and painstaking 
translations were of peculiar value. He married in 
1875, and died in 1882. 

Theodore H. Morris, expert mathematician and 
cricketer, Fred. W. Morris, classical scholar essayist, 
and poet, and Richard Pancoast, English scholar and 
humorist, were the triumvirate under which the Athe- 
naeum Society reached the acme of a brilliant pros- 
perity in our day. All three are successful business 
men. Theodore H. Morris was the first of our class 



COLLEGE EDUCATION 25 

to send a son to Haverford, and Fred. W. will doubtless 
soon follow his example. Pancoast, however, still 
remains a bachelor. 

Francis Richardson, brilliant in all things, but first 
of his class in mathematics, was also a famous pe- 
destrian, inclined to solitary pedestrianism, but was 
devoted also to "shinny," and was a strong man to 
have on one's side. Nurseryman, farmer, normal 
school superintendent, projector, builder, president 
of toll-roads and bridges, savings bank director, and 
secretary of a Norfolk Civil Service Reform Asso- 
ciation, he writes cheerily of the present, although 
his earlier post-Haverford life was saddened by the 
death of wife and child. 

The general scholarly attainments and a decided 
ability in debate, while at College, led us to believe 
that John W. Pinkham would probably enter the legal 
profession. Some of us were therefore somewhat 
surprised to learn that he had graduated in medicine 
and was practicing in Mont Clair, N. J., where his 
success had been all that could be desired. 

Who does not recall with pleasure the bashful Willie 
Corlies, on whose lips the smile of pleasure or the curl 
of contempt were alike becoming. An excellent 
English and Latin scholar, mathematics was his de- 
testation. Soon after leaving College, he entered 
mercantile life, which was little to his taste, and fail- 
ing health led him to seek foreign lands. After 
traveling for a time he settled in Paris, where he led 
the life of a student and also married. Bad health, 
however, again overtook him, and after two years of 
weary but patient suffering he died of the same fell 
disease which destroyed his classmate, Clark. He is 
buried at Royan, on the coast of France, where a 
simple stone marks his resting-place, located, in 



26 SELECTED ADDRESSES 

accordance with his request, on the shore of the ocean 
which washed his native land. 

And what of him who was the junior and has become 
the learned one of our class? Clement L. Smith was 
scarce seventeen when he was graduated, but the germ 
of the Harvard Latin professor lay in the Latin scholar 
of Haverford, and the oration, "De Alexandro Se- 
cundo, Russiarum Imperatore," was a fitting com- 
mencement to a career, as stages in which may be 
mentioned assistant professor at Haverford, professor 
at Swarthmore, tutor, assistant professor, and pro- 
fessor at Harvard. The Dean of the College Faculty 
of Harvard University requires no further touch from 
the brush of his classmate. 

Such, in brief, has been the fate of the Class of '60. 
While death has removed a fourth of our number, 
fortune has not been unkind to the remainder, and a 
reasonable success has met our efforts in the various 
paths of life we have chosen, so that in the main 
our lines have fallen in pleasant places. And while 
it is not for us to speak of our merits, I may be in- 
dulged to say to our revered mother, that I know 
of no demerits of these, her twelve sons, the narra- 
tion of which need put her to the blush of shame. 

Since the above was read Wm. B. Corbit, John 
W. Pinkham, Clement L. Smith, Richard Pancoast 
and Theodore H. Morris have gone over to the un- 
known country. 



II 

THREE SHORT ADDRESSES 



GIVEN AT THE 



CLOSING EXERCISES 

OF THE 

FRIENDS' CENTRAL SCHOOL 

PHILADELPHIA 
1891 — 1892 — 1893 



II 

THREE SHORT ADDRESSES 
1891-1893 



SIXTH-MONTH 19TH, 1891 

It is the natural desire of one selected to speak on an 
occasion like the present, to say something which will 
be helpful in the future of those most concerned — 
namely, the young men and women who are graduating 
to-day. This is not always easy, but it occurred to 
me that I might be able to show you in a measure that 
a store of wholesome pleasure and enjoyment is laid up 
for each of you in your journey through life if you can 
but lay hold of it. This world is so big, so beautiful, 
so bounteous in resources intended for our advantage 
that it would seem scarcely possible to overlook them. 
Yet too many of us learn this only after the opportu- 
nities once within our grasp have slipped away. How 
often is it said, had I my life to live over, how much 
more would I get out of it. To be able to tell you 
how you may get the best that is offered you, I fear is 
not in the power of anyone. I have however collected 
a few thoughts which seem appropriate to the oc- 
casion, which are humbly submitted. 

I believe the first condition of the proper enjoyment 
of life is physical health. If there be not health, all 
sources of happiness are barren. Happily, physical 
health to-day is much more closely looked after than in 
my boyhood. Then it was thought that if one felt 
well, it was not necessary to pursue any special course 
designed for the preservation of health, and, as a con- 

29 



30 SELECTED ADDRESSES 

sequence, while men and women continued free from 
signs of decay, the health was often being gradually 
sapped. To-day it is not so. The young are encour- 
aged to exercises and gymnastics of a rational kind 
which tend to develop symmetrically organs and func- 
tions whose harmonious operation is necessary to 
health. With a sound body and the clear head which 
grows out of it, the battle of life is half won. 

Given a healthy body there is no more fertile source 
of pleasure than a fondness for letters, science or art, 
or what is better still, for all. Anyone possessed of 
this has resources which may be availed of under al- 
most any circumstances, whether to lessen fatigue, 
to lighten care, or even to deaden a sorrow. The 
fulfillment of this condition may be said to be one of 
the important objects of the years spent in these 
schools whence you to-day graduate, with what suc- 
cess has been shown by what has gone before. I am 
sure those who are interested in you can only be grati- 
fied by what they have witnessed of your attainments 
and heard of your development. These results have 
not been secured without industry and effort on your 
part, and care and concern on that of your teachers; 
and while I do not wish to depreciate your own efforts, 
I want to bespeak a full recognition of those faithful 
friends, your teachers. Comparatively few appreciate, 
although I believe those who control these schools 
do appreciate, the debt we all owe our teachers for 
the patient, painstaking and unostentatious services 
they constantly render. If I were delegated to 
draw up a calender of saints of these latter days, I 
would make my first selection from among the teach- 
ers, not from pretentious, often selfstyled, profess- 
ors, whose assumption of the name has made me 
dislike it, but from the gentle, quiet, overworked and 
underpaid men and women, to whom many of us 



THREE SHORT ADDRESSES 31 

owe not only our mental training, but also our aspira- 
tions and ambitions, our characters, in fact all that we 
are. 

The course of study you have followed in these 
schools I believe to be the best of its kind, and well 
calculated to lay a foundation on which you yourselves 
may build a superstructure to serve the demands of 
almost any business or professional life as well as the 
purpose I have suggested. With some of you, doubt- 
less, and I wish it was going to be the case with all, this 
is but the beginning of a broader training in the college 
or the university. The ideal training, in my concep- 
tion, is the college course in every instance, even for 
those who go to business. This is, however, impos- 
sible for all. Those to whom the college or university 
is open, will find, unless I over-estimate the training 
received here, that they are not behind their fellows 
from other schools in the thoroughness with which they 
have been taught, and they will feel glad, as I did and 
as I believe all do who have had this opportunity, that 
they were prepared for college in the Friends' Central 
School. 

To those who will not have the chance of the broader 
college curriculum, there is still opportunity for self- 
education. To most the evenings are available for 
improvement, and even where this is not the case, it 
is astonishing how much can be accomplished in the 
odds and ends of time which are available to all of us. 
An excellent plan is to have a couple of volumes con- 
veniently at hand where one can take them up at any 
odd moment. Such a book would be one of Motley's 
histories, or a volume of essays, by Emerson or Lowell, 
or the cheery Dr. Holmes. By way of illustration, I 
may say I have myself read at odd moments, during 
the past year of a busy life, a charming volume — the 
1 'Memoirs of the Princess Alice," and in a previous 



32 SELECTED ADDRESSES 

year " Fanny Burney 1 and her Friends" and " Holmes' 
Life of Emerson." The numerous magazines of the 
day are replete with interesting and useful papers of a 
high order. The modern languages offer a field un- 
equaled in the value of the dicipline afforded, while the 
demands of modern professional and business life make 
them almost indispensable to the highest success, to 
say nothing of the pleasure and profit derived from a 
study of literature in the original tongues. It is too 
early yet to determine the exact value of the Univer- 
sity Extension methods, but thus far they have afforded 
in Philadelphia at least, intellectual entertainment of 
the most acceptable kind, while it is not unreasonable 
to expect that the more ambitious purposes of the 
movement will be accomplished. 

Another source of pleasure and profit allied to the 
foregoing is travel. Nothing is so attractive, nothing 
so improving when carried out in the right way. In 
fact, it is scarcely possible to be anything else than 
improving. Who has not seen the effect on the mind, 
the speech and the bearing of one who has well spent 
a year, or even a few months, abroad. Scarcely less 
marked is the effect of travel in our own country, 
while the enterprise of a Raymond or a Cook has 
opened to those in moderate circumstances a thousand 
opportunities formerly available only to the rich. 

Your comfort and happiness are greatly influenced 
by the nature of your relations toward others. In 
these schools, and especially in what has been said 
to you in the religious meetings you have attended in 
connection with your school duties, you have been 
taught that forbearance and courtesy are of the first 
consideration. The effect of such teaching on those 
who have gone before you has no more striking illus- 
tration than what I recently read of an interview 

1 Madame D'Arbley. 



THREE SHORT ADDRESSES 33 

between a reporter and ticket agent in a great rail- 
road station. The latter, in reply to the reporter's 
question, said the politest and most considerate of his 
patrons, they with whom his relations were the most 
pleasant, were the Quakers. This is no new evidence 
to the effect that the most potent weapon against 
discourtesy is courtesy. Ninteen hundred years ago 
this was proclaimed as one of the fundamental prin- 
ciples of a purified religion. Yet no religious body 
appears to have been as efficient in making it a part of 
the conduct of life among its people as the Friends. 

In your relations to others as employers or ser- 
vants, and we are all servants in a sense, let your 
single rule be to do everything you are called upon 
to do in the best possible manner. That you are 
illy paid for what you do is no justification for slighting 
what you have engaged to do, while the obligation 
exists. If your compensation is insufficient, or you 
feel that your work is not appreciated, you are justified 
in severing the relation after you have complied with 
its conditions. But you will not only increase your 
chances for securing justice, but also of obtaining 
further employment, to say nothing of satisfying 
your own consciences, by fulfilling every obligation, 
however trifling, which rests upon you. I am very 
fond of an old and very simple maxim, which reads, 
Minimum minimum est, sed fidelis esse in minimum 
magnum est — a very little thing is a very little thing, 
but to be faithful in a little is great. To act upon this 
truth will be found a safe rule in the conduct of life in 
almost any sphere. To those who will be in the 
position of employers, as doubtless some of you will 
be, I bespeak the same consideration for those sub- 
ordinate to you as you would ask for yourselves. 

But notwithstanding anything that I may say, or 
any one may say, or anything you may do, the life 



34 SELECTED ADDRESSES 

of each one of you will be more or less chequered. 
You will have your gay moments and your sad 
moments, you will have your successes and your 
failures which each must meet with such dignity and 
resignation as he or she can best command, and if 
aught that I have said may heighten a pleasure, or 
lighten a care, I shall feel more than repaid. But, 
far easier will it be for you if there has come to you 
the unspeakable privilege, which does not come to all 
alike early, even if sought for and prayed for — the 
privilege of a faith that all events are ruled by a 
Providence which is guarding the least of us, and per- 
mits pain, misfortune and affliction only for the sake 
of their chastening and purifying influence. 

II 

SIXTH-MONTH 17TH, 1892 

I believe it comes to most men and women with 
that maturity of age that leads to greater thought- 
fulness, and sometimes seriousness, to want to help 
the young, to desire to do something for them, which 
will smooth their pathway in life and make it easier 
for them. I am quite sure, therefore, that I am not 
the only one in this assembly to-day who is yearning 
to do this for the young of both sexes who have 
just been crowned before us. Yet they who have 
been in my position realize the difficulty of doing 
this, at least by words alone, to which we are under 
the circumstances limited. 

In the first place, we are met on the threshold 
with the truth acknowledged by all who have had 
experience, that it is not always best that the path 
of life should be too smooth at first, and that trials 
and disappointments are even desirable, by reason of 



THREE SHORT ADDRESSES 35 

the wholesome lessons they bring with them; while 
it too often happens that the easy attainment of op- 
portunities and ends in early life begets a confidence, 
and even an arrogance, that lead to a chagrin and a 
humiliation which an earlier and less severe experience 
might have averted. 

Believing, therefore, that it is advantageous, rather 
than harmful, to encounter a certain measure of the 
vicissitudes of fortune in early life, it becomes the 
task of the friend of youth to indicate the best way to 
meet them, rather than to suggest a means of avoiding 
them, even if the latter were possible. 

Again, the term happiness is a relative one, and to 
a large extent the events of a life are what we make 
them, by the way in which we receive them, and 
view them; while we receive them and view them 
largely according as we are constituted ourselves. 
It does not take a long life to teach even the casual 
observer that to the sound mind in a sound body an 
event may be pleasurable, which to an invalid may 
be fretting and irritating. Between these two ex- 
tremes there is every degree of mental and physical 
constitution, which interprets events in accordance 
with it, while habit and discipline further co-operate 
to produce the various grades of disposition, good 
and bad, which belong to men and women. One 
man may spend a lifetime in encountering diffi- 
culties, in which repeated disappointment, and even 
physical suffering, may be conspicuous, and yet 
the life may be regarded as a happy and contented 
one. Another will be surrounded by luxury, and 
have every wish and whim gratified, and yet be truly 
wretched. 

What is the difference between these two individ- 
uals? Throwing aside the effect of ill-health, which 
should be temporary, and allowing for an hereditary 



36 SELECTED ADDRESSES 

sunniness of nature, which is, perhaps, only the sur- 
viving effect of discipline in a previous generation, 
the disposition of the former has been influenced by 
example, the training of parents, guardians, or 
teachers, or self-imposed, through the operation of 
a principle, which has become the guiding star of a 
life, and the motive of all its actions. Such a motive 
may, for example, be a religious inspiration. Or all 
of these may combine to produce in various degrees 
an effect. 

That I should expect to be able to take the place 
of any of these agencies would be an assumption 
wholly unwarranted. Yet as a pebble sometimes 
turns a stream I may be justified in hoping that to 
my words may be permitted a like chance of influenc- 
ing some young person in the hearing of my voice. 
In the first place, it is a grave mistake to suppose 
that a life is easy which is without some serious occu- 
pation. "In the sweat of thy face thou shalt eat 
thy bread, " was not said without a purpose, and 
experience abundantly teaches that it is no less true 
of those whose idleness is seemingly excused by the 
possession of wealth, than of those who are from acci- 
dental circumstances unemployed beyond the time 
demanded for wholesome recreation, that discontent, 
misery, and even crime are favored by the conditions 
thus furnished. My respect and admiration of those 
who "work for a living/ ' as the word goes, with mind 
or body, or both, is so great that I sometimes fear I 
am unfair to those whom fortune has seemingly 
favored, by placing them in a position in which their 
wants are supplied without work. But I have seen so 
much of the gradual deterioration of mind and body 
and morals in such that I count the inheritance of 
money in large amount a questionable advantage. 

Having accepted the truth that occupation of some 



THREE SHORT ADDRESSES 37 

sort is essential to a wholesome life, the next lesson to 
be learned is that of prompt obedience to the rules or 
conditions by which such occupation is surrounded. 
It is presumed, of course, that the principle of obe- 
dience has been impressed upon you long ere this, 
for it has been well said that obedience should begin 
in the cradle, but my object is to impress upon you 
that the law of obedience is not confined to child-life 
alone, but must be kept in sight at all periods, and in 
all situations in life. There is nothing that develops 
the best traits of manhood and womanhood more 
than a prompt response to whatever may be required 
of us in our various lines of duty. It is this which 
secures the most thorough efficiency in all systems of 
training and business. Nowhere is it seen more 
strikingly than in the ability beyond his years, the 
manly bearing and bravery of the youthful officer 
who has passed through the national military academy. 
And although we as Friends have no use for the 
soldier in our system, we cannot but admire the effect 
of his discipline and training. It is these which make 
the well-trained nurse at once the thorough gentle- 
woman that she is, and the efficient servitor, per- 
forming promptly duties from which one not so trained 
would shrink in dismay. It is these which ensure the 
safety through tempest and fog, of the colossal ocean 
steamer with its precious freight of human life and 
merchandise. 

A common misapprehension of the young is that it 
is possible to go through life and escape what is com- 
monly called drudgery, in occupation and employ- 
ment. There is no greater mistake than this, and 
those who have achieved the highest success in any 
profession or occupation will tell you that drudgery 
is the hand-maid by whose aid they have climbed the 
ladder of success, and that he who would attempt the 



38 SELECTED ADDRESSES 

ascent without her assistance will certainly fall 
before he has passed far beyond the first round. 
The successful merchant has, perhaps, swept the 
floor, done errands or carried samples over the land 
for years before he was invited to an interest in the 
firm. The influential railroad manager has probably 
carried the chain in the surveyors' gang, or even 
handled luggage before he has attained his towering 
influence. The 3^oung lawyer has copied hundreds of 
deeds and conveyances before he took his first brief, 
while the young doctor has wound his way through 
narrow courts and up rickety stairs, into the filthy 
homes of the squalid and even criminal poor, to get 
the experience which will enable him to reach down 
deep into the pockets of the rich, and still lend a 
helping hand to the worthy poor. The artist whose 
" Heart of the Andes" or whose "Angelus" carries 
his fame into every clime and every language, has 
spent hundreds of hours in doing and undoing work 
which is finally thrown aside in disappointment and 
disgust. The poet, whose touching stanzas melt a 
nation to tears, or the orator whose eloquence sways 
a populace as a breath of air a field of waving grain, 
has perhaps erased and rewritten and again destroyed 
a score of attempts before he has composed the few 
lines which seem to flow from his lips as the waters 
of a stream past its banks. All will tell you there is no 
royal road to success any more than to learning, and 
that drudgery is the hand-maid of success. 

Courteousness and cheerfulness are similar help- 
mates toward a happy life. A courteous bearing to 
all whom you encounter, whatever their social sta- 
tion, will generally secure you a like courtesy which 
will save you many of the minor annoyances which 
go to make up the sum of one's discomforts in life. 
No proverb is truer than that a "soft answer turneth 



THREE SHORT ADDRESSES 39 

away wrath." In the respect of this injunction you 
have had in these schools the advantage of both 
precept and example in the association with the 
teachers who have had to do with you. In like 
manner cheerfulness, even if a little forced as it 
must be at times with all, because none of us are 
without our sad moments, is retroactive and soothing 
on one's self, to say nothing of the encouraging effect 
upon others. I known one man whom I never visit 
without leaving him better satisfied with myself and 
all of the world besides, while from another friend, I 
am apt to part in an opposite frame of mind. 

Finally, there is a means of brightening the jour- 
ney through life which, within a few days passed, 
has been so well treated on a similar occasion by one of 
whom this society is justly proud as a scholar and 
educator, that I hesitate to touch upon it. 1 Yet it is 
so far-reaching in its effects and so within the grasp 
of all that I cannot forbear an allusion to it. It is 
the practice of doing something for others regardless 
of self, something to increase their pleasure or diminish 
their pain. It is especially during periods of sadness 
or trial through which we may be passing that the 
greatest comfort is derived from such ministrations. 
It was thus with the hero of that delightful and 
wholesome story for boys, and for girls as well, "Tom 
Brown at Oxford," who, at a time when life was 
seeming so desolate as to be scarcely worth living, 
undertook to help his friend, Grey, the curate, with a 
picnic he had arranged for the poor children of West- 
minster, a motley collection of les enfants terribles of 
London. You will remember the day was over, the 
children had had a splended time and were coming 
home through Hyde Park, the vans having been dis- 

1 Adress of Ex-president Magill to Swarthmore Students, June 15, 
1892, and published in Friends' Intelligencer for June 11, 1S92. 



40 SELECTED ADDRESSES 

charged by Grey out of consideration for the drivers 
and their horses. It was the hour of day when the 
"drive" was crowded with carriages and Rotten Row 
with equestrians of both sexes, among them, likely 
as not, many of Tom's friends. Before these thorough- 
fares were reached Tom heard at his side a plaintive 
voice "Oh, please, won't you carry me a bit, I am so 
tired?" He looked down and saw a delicate, shabbily 
dressed girl whose confiding and trustful manner had 
attracted his attention more than once during the day. 
She was lame and so tired she could scarcely drag 
herself along. He hesitated, and again the piteous 
voice and pleading gray eye attracted him, when, 
raising her on his broad, strong shoulders, he marched 
along regardless of the gaze and supercilious smiles of 
the throng. They had crossed the "drive" and 
"Rotten Row" and were well into Belgravia, and Tom 
had almost forgotten the situation in listening to the 
prattle of his little burden, when a shout arrested his 
attention and he found himself almost under the feet 
of the horses of a riding party in which he recognized 
Mary Porter, and was recognized in turn by her, her 
father and the arch enemy, St. Cloud. But you know 
the episode and its delicious termination for Tom, and 
if you are not familiar with it you will enjoy more the 
reading it than to hear its recital in a bungling way 
from me. 

Not all of you will have the sweet recompense for 
your good deeds that Tom had, though I hope some 
of you may. On the other hand, you will find with 
all your efforts to do what is right and to be just to 
others and to help others, matters will still sometimes 
go awry. That will happen which should not have 
happened, and what should have come to pass will 
not come to pass, and so your patience will often be 
sorely tried. If, under these circumstances, you will 



THREE SHORT ADDRESSES 41 

receive a grain of comfort from anything I have said, 
I am sure I will be more than repaid for any effort I 
have made in your behalf to-day. Much more easily 
may you remember and doubtless to greater purpose, 
too, the rhythmic measures of the poet, in the lines 

"For consequent upon the learning how from strife 
Grew peace — from evil good — came knowledge that, to get 
Acquaintance with the way o' the world, we must not fret 
Nor fume, on altitudes of self-sufficiency, 
But bid a frank farewell to what — we think — should be, 
And, with as good a grace, welcome what is — we find." 

Robert Browning. 

Ill 

SIXTH-MONTH 16TH, 1893 

It is quite usual under circumstances like the 
present, in the desire of a speaker to say something 
which may serve a useful purpose to those for whom 
the occasion is a special one, to call for data on the 
experience of years, in a word to draw upon the wisdom 
which age alone is supposed to be able to give. I 
propose, however, in the very few words I shall say 
to-day, to reverse the usual order, and to speak from 
youth to age instead of from age to youth. For age 
is not the only period of virtues and good qualities, and 
I believe it will not be difficult to show that youth 
possesses attributes which age can illy afford to dis- 
pense with, and which are often too soon allowed to fall 
away as though they were not a part of the mantle of 
maturity and should be shed with its approach. 

To me youth has always seemed like a charming 
valley landscape, checkered with greens and browns 
and golden yellows, sparkling streams and island 
woods, and shades of moving clouds; and though 
flecked at times with the deeper shadows of fleeting 



42 SELECTED ADDRESSES 

sorrow, for the sorrows of childhood are always 
fleeting, still radiant with the sunlight of hope. 
Early manhood I would liken to the foot hills in 
Nature's picture, more distant and exacting of him 
who would see their splendors, but still bright and 
beautiful in the light of expectant hope. In maturity 
I see the sterner mountain passes, curtailed in the 
number and variety of their beauties, with shadows 
deep and sombre, but still grandly sublime in the 
alternation of these with the brighter touches of the 
higher slopes. In old age there is the summit; it may 
be calm and dignified in the possession of the fruits of 
successful effort, or bare and naked of results, but in 
either event, solitary, looking down upon the varied 
beauties of foot hill and valley, beauties magnified by 
the fact that they are no longer within reach, though, 
perhaps, lightly valued when possessed. 

I am inclined, therefore, to reverse the order 
to-day, and let age take a lesson from youth, or, 
perhaps, I should say, your age from your youth. 
And, first of all, I would speak of the joyousness of 
youth. The crowing of the infant, the rollicking 
contagious laughter of the boy and girl, the more 
subdued gayety of early manhood and womanhood, 
all point to joyousness as a natural attribute of youth, 
alas! often too soon thrown aside with the approach 
of maturity in the mistaken idea that it is inappropri- 
ate. This is not as it should be, and there is abundant 
evidence to show that the Creator never intended 
joyousness to go out of life with youth, or to be left 
behind when man enters upon a religious life. "The 
habit of joy is as necessary a preparation for living in 
God," says a recent writer, "as is that of consecration. 
A gloomy, despondent, joyless person will be no more 
fit for heaven than any other sinner." 

Scarcely less characteristic than joyousness is the 



THREE SHORT ADDRESSES 43 

hopefulness of youth. It has been said of hope that 
it is like the sun, which as we journey towards it, 
casts the shadow of our burden behind it. 1 In this 
respect youth offers age an example which, is too 
seldom followed. How often do we needlessly place 
the shadow of our burdens before us because we travel 
away from hope rather than towards it! I beg you, 
therefore, cling to hopefulness throughout life, in 
adversity and in prosperity. Hope, again, may be 
defined as courage, and to be hopeful is to be courage- 
ous. With the death of hope courage dies, and the 
brightness of life goes out. 

Age may take a lesson from youth, too, in sym- 
pathy , which certainly has its most natural expres- 
sion in the young. There is no affectation in the 
sympathy of youth, no artificiality. It is sponta- 
neous, too, and from the bottom of the heart, and too 
often with the growth of years gives place to a species 
of sympathy which abounds in well-sounding speech, 
and even conspicuous acts, but does not comfort us 
because it bears the stamp of insincerity. Sympathy 
is simple, and is sometimes most deeply felt when 
unspoken. Sympathy is, indeed, but another word 
for love — love in the broadest sense — love of the 
human race, such as "this, that through it a man lay 
down his life for his friend, " and "than which there 
can be no greater love." 

There is, however, one kind of love of which the 
child is ignorant, which is altogether an after-growth, 
and which, sad to say, is often a co-development with 
personal merits and virtues, the contemplation of 
which even tends to stimulate it. I allude to self- 
love. This was so thoroughly appreciated by a 
great moralist and writer, and is so well illustrated 
in his words, that I cannot refrain from quoting 

1 S. Smiles. 



44 SELECTED ADDRESSES 

them: "The inordinateness of our self-love makes 
speech about ourselves like the putting of a lighted 
torch to the dry wood which has been laid in order 
for burning. Nothing but duty should open our lips 
upon this dangerous theme, except it be in humble 
confession of our sinfulness before God." 1 Self- 
love is the besetting sin of all of us. It is so insidi- 
ous in its growth that we become victims without 
being conscious of it, and we need forever to be on 
our guard against it. To this end the same writer 
says: " Think as little as possible about any good in 
yourself; turn your eyes resolutely from any view of 
your acquirements, your influence, your plans, your 
success, your following — above all, speak as little as 
possible about yourself." To self-love true love is 
antagonistic, destructive. This truth, too, is beauti- 
fully expressed by the sublimest of modern bards 
who, alas! too, has sung for us his last song: 

"Love took up the harp of Life, and smote on all the 

chords with might, 
Smote the chord of Self, that trembling passed in music 

out of sight." 

And what shall I say of faith? At no age do we 
see it simpler, purer, larger, than in youth. The 
infant clings to its mother with the certainty that it 
is protected in her arms as nowhere else. The boy 
takes the hand of his father confident that in it is the 
guide which will never fail him. It is only as we 
grow older and our experience teaches us that our 
faith is at times misplaced that it weakens, and is too 
often followed by its opposite, misanthropy. For- 
tunate is he, who, with the transit of years keeps 
hold of, at least, a portion of that faith in his fellows 
which I believe is inborn with all of us, and which 

1 Bishop Wilberforce. 



THREE SHORT ADDRESSES 45 

we only lose because it has sometimes been poorly 
requited. Let us array ourselves against such ten- 
dency. Better is it to suffer the heartache of a dis- 
appointment in our faith than to have had no faith, 
or, to modify a more familiar saying — it is better 
to have had faith in vain than not to have had faith 
at all. 

Charity, alone, perhaps, of the three virtues of 
which it is said to be the greatest, requires a certain 
maturity of mind and inculcation to establish it. It 
may be said to be the most intellectual of the virtues, 
seeming to be less a natural endowment than a matter 
of education. With this exception, however, the 
virtues considered are inherent in youth, and it is 
their gradual decadence with growing years which 
detracts from the perfect man and woman, and makes 
them less than something lower than the angels. 

Such is the lesson I would draw from youth to 
age, from your youth to your age, a lesson which 
may help you if sometimes recalled. The fountain 
of youth is not perennial, and the secret of its per- 
petuity will be forever hidden, but there is no reason 
why its rainbowed mist should not surround us 
through our maturer and older age, not with a fitful 
or unsteady glimmer, but with a continuous though 
subdued luminosity that will brighten the later life 
as the afterglow the path of the wayfarer at nightfall. 



Ill 

THE OFFICE OF THE COLLEGE AND THE 
DUTY OF THE GRADUATE— 1906 



Ill 

THE OFFICE OF THE COLLEGE AND THE 
DUTY OF THE GRADUATE 

Managers, Faculty and Friends of Haverford 
College, Members of the Graduating Class: 1 
More than four decades have passed since I stood upon 
a platform of which this is the direct descendant, in 
response to the announcement Expectation Carmen in 
lingua Latind Tuson. The poem entitled " Ad Italism 
Resurgentem" was supposed to have been written in 
choice Horatian verse. That the meter was good was 
assured by the fact that it was supervised by our 
beloved then Professor of Latin, and Greek, Thomas 
Chase. That its poetry was dim and shadowy it is 
needless to say, because the narrative poem is feeble 
even in the hands of the experienced poet; much more 
so in those of the tyro whose sole ability lay in his 
power to build up verses out of dactyls, spondees and 
trochees. Since then, changes many and great have 
taken place in Haverford. In that day Founder's 
Hall, the Observatory, the Gymnasium, wash room 
and carpenter shop constituted the College buildings, 
although the same broad acres of beautiful lawn sur- 
rounded them then as now. But no stately hall of 
Barclay or Roberts, or new Gymnasium or Library 
or spacious Dining Hall then adorned the ground. 
Nor do they now shelter more loyal sons than did the 
old buildings of my day. 

If we examine the roll of that day we find the names 
of men of such mark as to have it said of them, 
whence came they? What their training? What 
their Alma Mater? It was the memory of these, 

*Read on Commencement Day, June 15, 1906. Not previous^ 
printed. 

4 49 



50 SELECTED ADDRESSES 

many of whom have crossed to the unknown coun- 
try, some in response to their country's call — the 
memory of the older days as well as my interest in 
the present of Haverford that made me specially 
glad to accept the invitation to speak to the gradu- 
ating class and the many friends of the College gath- 
ered here to-day. 

Two decades and more have passed since I addressed 
the Alumni Association of Haverford on the Require- 
ments of a Modern College Education. It seemed a 
fitting sequel of that address to continue the same train 
of thought to-day and speak briefly in the first part of 
my address of the duties or functions of a College. 
At first thought it does not seem difficult to define a 
College. Thus, quoting from the Century Diction- 
ary, the authors say, "In Scotland, the United States 
and Canada, a College is an incorporated and en- 
dowed institution of learning of the highest grade.' ' 
How meagre this definition, how totally it fails to 
convey any idea of the real purpose of a College! 
A more satisfactory definition would appear to be one 
specifying some of the objects of the College. To 
the superficial thinker the acquisition of knowledge 
seems the foremost. But, although of great impor- 
tance, it falls far below that of the training of the 
faculties of the student and the development of 
qualities which give him power for good; qualities 
which fit him to influence and lead others, the qualities 
which identified George Fox, William Penn and 
Robert Barclay, with the early history of the Society 
of Friends, and made them leaders in it. To this 
office of the College should be added the moral and 
physical training of its students; and finally the ac- 
quisition of knowledge. 

Taking up first the training of our faculties, its 
object may be said to be education in the true sense 



THE OFFICE OF THE COLLEGE 51 

of the word, the educing or leading out the qualities 
and powers named, as contrasted with the acquisi- 
tion of knowledge. One need not go far to discern 
the results of this training at different stages of a 
college course. Who has not noted the difference 
between the crude Freshman and the smart Sopho- 
more? Between the Sophomore and the dignified 
Junior? Between the Junior and the patronising 
Senior? These are superficial differences but be- 
neath them are greater and abiding ones. And accord- 
ing as a College has succeeded in quickening and en- 
larging these faculties, in converting the boy into the 
self reliant, forceful man, it has become successful in 
the most important of its functions. 

But such a training and development of qualities 
refer to mental capacity or ability regardless of its 
direction. It is evident therefore, that without some 
limitations it might result in the promotion of evil 
rather than good, of wrong rather than of right. 
Hence the moral training of its students becomes an 
indispensable function of a College. It does not lie 
in my province to-day to lay down the amount or 
method of such training but simply to insist upon it 
as essential. Yet when I look back through the vista 
which time has wrought between the present and the 
far off days of my student life at Haverford, I recall 
nothing so impressive as the picture of the quiet hour 
in Meeting and the recitations from Dymond's Essays 
and Paley's Evidences; recitations to the venerable 
Paul Swift, whose remarks and explanations were 
heard in silent awe, emphasized at times by the black 
cloud and thundering voice of displeasure when some 
unfortunate boy gave evidence of deficient preparation 
or lagging interest. There remains to me, too, a 
pleasant memory of the lessons from that admirable 
and to me still attractive text-book, Haven's Mental 



52 SELECTED ADDRESSES 

Philosophy, as elucidated by Prof. Chase, and the 
Wednesday morning instruction in the Greek testa- 
ment also by Chase, including the Sermon on the 
Mount which we were required to recite in Creek. 

Essential to the fulfilment of the conditions men- 
tioned is a sound mind in a sound body, in other words 
the good health of the student. It is accordingly 
the duty of the College to secure and maintain this 
by suitable measures, including the physical examina- 
tion by a competent physician and rational exercises 
in the gymnasium, directed to securing a symmetrical 
development. As a measure useful in the promotion 
of physical development must be included the athletic 
games which have assumed such importance in the 
modern College life and are exciting so much discus- 
sion at the present day. The chief advantages of 
athletics is that they add pleasure or amusement to 
the exercise — such pleasure being derived from the 
game itself, or from rivalry between contestants 
whether in intra or inter collegiate contests. The 
drawback to exercises in the gymnasium is their 
failure to excite interest or pleasure, being often 
regarded as a bore or nuisance by those who should 
practice them. What is wanted is a combination of 
play and exercise. Such the athletic games afford 
and as such they fulfil a useful purpose. On the 
other hand, they do not tend especially to produce 
symmetrical physical development, and it is a remark- 
able fact that those who engage in them are not 
freer from disease and do not live longer than those who 
do not. While contributing therefore to a wholesome 
life they do not of themselves sufficiently ensure it. 
On the other hand, physicians are often consulted in 
after years for the jaded heart whose failure is as- 
cribed by its owner to the strain of the rowing match 
or the repeated struggles of the football game. As 



THE OFFICE OF THE COLLEGE 53 

soon as athletic games become dangerous to life or 
cease to contribute to a wholesome life, as soon as 
they crush the spirit of human sympathy or kindness, 
or develop a surliness which smothers a cheer at a 
rival's success, or become an instrument of college 
advertisement, a magnet to attract students, then they 
become an excrescence on the College life which 
should be excised at the root. 

Ideal gymnastic exercises wo aid include mental as 
well as physical training combined with pleasure, 
and experiments in this direction in which the co- 
operation of music is sought to emphasize the rhythm 
of the body have been made. The former idea has 
been especially fostered by Professor G. E. Johnson, 
formerly of Clark University, while Professor R. 
Tait McKenzie of the University of Pennsylvania 
has developed the gymnastic drill in large classes to the 
accompaniment of music to a point which has made 
it a pleasure, not only to the large body of student 
participators but to the spectator as well, and quite 
recently I enjoyed an opportunity to watch the 
rhythmic movements of several hundred white uni- 
formed students to the inspiring music of a band which 
to me appeared far more attractive than the rush and 
conflict of the football game. 

It has always seemed to me that Haverford has been 
fortunate in its pre-eminence in a game which is at 
once effective from the physical standpoint, clean in its 
moral tendencies, and liberalizing in its effect on the 
true sporting spirit — namely — cricket, which as an 
American College game I believe was first introduced 
here. 

Finally the acquisition of knowledge is no unimpor- 
tant function of a College. Largely a means to an end, 
viz., that of training and development as already dwelt 
upon, it is also knowledge for knowledge's sake; 



54 SELECTED ADDRESSES 

valuable for its intrinsic usefulness, and should be 
selected with this end in view, as well as for the first 
object named. Its full consideration involves that 
of the details of the curriculum, which is no subject for 
an occasion like the present. To one matter only. I 
will allude. The bane of modern College education in 
America as compared with Europe, and especially 
with Germany, is a certain superficiality or absence of 
accuracy which places our students at a disadvantage 
with those trained abroad. Of this I have reason to 
believe Haverford is free. In evidence I have again 
to refer to my own experience. I went from Haverford 
to a large medical school, where if anywhere one would 
expect the facilities in chemistry to be of the best, and 
where probably they were the best of their day; but 
outside of a little organic chemistry nothing was 
taught that I had not already mastered from Stock- 
hardt's chemistry aided by Dr. Swift and the little 
laboratory at Haverford, since supplanted by the 
present large and well-equipped laboratory, 

To you, young men, to whom the present occasion is 
the commencement of another stage in your lives, I 
have first to extend congratulation on the attainment 
of the goal for which for four years you have been 
striving. It is a great privilege to have graduated at 
Haverford. The purpose of its foundation to furnish 
" a guarded education in the higher branches of learn- 
ing, combining the requisite literary instruction with 
religious care over the morals and manners of its 
scholars," the liberality and conscientiousness of its 
management, the refined scholarliness of its professors, 
the charm of its beautiful and extensive grounds, the 
manliness and purity of its athletics, have given it a 
unique and enviable position of which its friends may be 
justly proud. You enter the beginning of this new 
stage of life — your commencement — with the stamp 



THE OFFICE OF THE COLLEGE 55 

of an Alma Mater which will pass current wherever 
culture and refined scholarship prevail. I beg you 
remember however, that this stamp, this cachet is 
not given you for ornament only, but for a purpose. It 
It is a talent entrusted you, which Haverford expects 
you to keep well employed. Yet it is not amiss of 
you to ask of me some suggestion of conduct or method 
which may aid you in discharging the obligation I 
have laid upon you. To the sum of the offices 
of the College which I have laid down and by which 
you have profited, may be correctly applied the some- 
what overused and often misused word "culture." 
Culture is commonly spoken of as a condition. I 
prefer to regard it for my present purpose at least, 
rather as an active process. To continue this active 
process of culture after you have left the shades of 
Alma Mater is to employ well the talent entrusted 
you. Nor need there be any gap in your effort, for 
your endeavor may continue tomorrow where it left 
off today. Of the various aids to the success of such 
endeavor I shall speak of three which commend them- 
selves, of which one at least is indispensable to culture, 
the second nearly so, while the third although less 
essential is a most useful hand maid. They are work, 
reading and travel. The first of these is a thread on 
which hang all others and which also runs through 
everything that is worth accomplishing. Everything 
that we have, comes by work and nothing good comes 
without it. But more than this, work is a sovereign 
remedy. It drives away harassing care, mitigates 
disappointment and softens sorrow and in the end 
cures it. But work is more than a cure; it is what 
doctors call a prophylactic. It prevents illness by 
occupying the mind in a wholesome way, keeping 
away real and imaginary ills, and above all, keeps one 
out of mischief. Work must therefore be the first 



56 SELECTED ADDRESSES 

device on the banner you will bear aloft after you leave 
Haverford, not only in the profession or occupation of 
your choice, but in that further broadening of knowl- 
edge and development of your faculties of which 
Haverford has laid the foundation. But work has 
also its limitations. This has been shown over and 
over again by the experience of thousands who seek to 
disprove it by violating nature's laws. Remember the 
injunction " Work while it is day, for the night cometh 
when no man can work." The measure of the results 
of work is its thoroughness, whence also the scriptural 
injunction " Whatever thy hand findeth to do, do it 
with all thy might." These two injunctions remem- 
bered, work becomes an indispensable, safe and power- 
ful adjuvant to culture, health, success and happiness. 
A never failing source of culture are books. It is 
true that "of the making of books there is no end," and 
many are not worth the paper on which they are 
printed. Fortunately, the sort of literature which is 
most useful for our purpose has not increased as much 
as that which is barren of results to the reader, but, 
alas, the sifting of the wheat from the chaff is a 
laborious process. Hence it is that the older writings 
are so much more serviceable to us than the very 
modern. With them the sifting has been done, the 
chaff has been removed. It has been in fact a survival 
of the fittest and that which remains is choice and 
classic. In the older literature I include the Greek and 
Roman Classics and especially the Greek and Roman 
poets, which abound in original thought and fancy, 
set in a wondrous beauty of phrase and rhythm. It 
is not of course necessary that these should be read in 
the original. Thought is the same in Greek and Latin 
as in German, French and English and it is often 
rendered as prettily or nearly as prettily in these 
languages as in the original. Of all the Latin poets 



THE OFFICE OF THE COLLEGE 57 

Horace is the most cheerful and most sparkling and 
his meters the most musical. Who that has read them 
will forget his many beautiful odes to his patron 
Maecenas, others to Vergil, to the many Lydias who 
enjoyed his friendship, to Chloe, to laughing Lalage, 
to Phyllis. Of the Greek poets Homer is most 
majestic and he is evidently superior to Vergil in 
his rendering of the same story. Recall the lines of 
Sheffield, Duke of Buckinghamshire: 

"Read Homer once, and you can read no more; 
For all books else appear so mean, so poor, 
Verse will seem prose; but still persist to read, 
And Homer will be all the books you need." 

Tragedy received its intensest expression in the plays 
of Euripides, Sophocles and Aeschylus, while the 
spirit of true comedy is nowhere better illustrated than 
in the comedies of Aristophones. 

We must not however ignore the prose writers of 
Greece and Rome. It would indeed be strange if we 
could find nothing contributing to culture in the prose 
writings of the people who, says Henry Symnet of 
Maine, created the principle of progress. I need only 
mention Socrates, Aristotle, Plato and Hippocrates 
to refute such suggestions. Of Latin prose writers I 
need mention only Marcus Aurelius, Epictetus and 
Cicero as exponents of an ethical code, unsurpassed in 
lofty ideals well worth the devotion of a leisure hour, 
while the Plinies and Plutarch in their histories invite 
us to original sources of information, much more inter- 
esting than those commonly served at second hand to 
the student of today. To any one desiring to note 
how similar were the trivial incidents of the home life of 
aristocratic Romans to the like events in the life of the 
same class at the present day I commend Cicero's 
letters, especially those to his wife Terentia and beloved 
daughter, Tullia. The querulous lamentations of an 



58 SELECTED ADDRESSES 

unhappy, disappointed and vain man, fretting away 
his life in exile, as they flow from his facile pen in the 
purest Latinity might have been written by the most 
accomplished statesmen of modern times under like 
circumstances, as for example Charles Sumner or 
Edward Everett. 

Of English literature the models of style are also the 
older writers including Shakespeare and Milton, Fuller 
and Sir Thomas Brown, Pope and Dryden. The 
poets and prose writers of the Victorian age, than which 
there are no more brilliant in English literature, have 
not been replaced by anything more recent; and 
Wordsworth, Carlisle, Tennyson, Coleridge, Chas. 
Lamb, Walter Savage Landor and Walter Pater; and in 
this country, Longfellow, Whittier, Washington Irving, 
Emerson, Lowell, Oliver Wendell Holmes, Henry Van 
Dyke, still furnish the most improving literature. 

Travel, which is the third device on our banner, can 
scarcely be considered apart from books, for books are 
the inspiration of travel; while travel has inspired 
many of the most celebrated and most instructive of 
books and writings. The improvement derived from 
travel is altogether different from that derived from 
books. Reading develops the memory and stores the 
mind with interesting and useful facts which furnish 
food for thought and topics of conversation with others, 
while travel exercises the perceptive faculty, develops 
the appreciation of grandeur and beauty in nature and 
stimulates the aesthetic senses generally and the imagi- 
nation. Above all it refreshes the weary body and 
mind and renews them for further effort. More than 
this, there would seem to be some insidious improving 
effect which is intangible but which nevertheless is 
potent towards culture. I have seen a young man 
return from a brief tour abroad of even a few weeks, 
present such improvement mentally and physically 



THE OFFICE OF THE COLLEGE 59 

that one wonders how it came to pass, yet it was 
evident. Even Emerson who disparaged travel and 
said some rather disagreeable things about it, said also 
"the influence of fine scenery, the presence of moun- 
tains appeases our irritations and elevates our friend- 
ships. Even a high dome and the expansive interior 
of a cathedral have a sensible effect on manners. I 
have heard that stiff people lose something of their 
awkwardness under high ceilings and in spacious halls. 
I think sculpture and painting have an effect to teach 
us manners and abolish hurry. " 

For such objects as these we travel and I strongly 
urge upon you to avail yourselves of every opportunity. 
If necessary, stint and deny yourselves luxuries and 
even less than luxuries in order to save up for the 
summer trip at home or abroad, either afoot or by 
rail, by cycle or auto, as your purse may justify, but 
remember that what we accomplish by effort is more 
abiding in its results than that which we acquire with 
ease. 

Work, books, travel; these are tho talismanic words, 
which, guilded on your banner and graven on your 
hearts, may be the battle cry in the bloodless contest 
for culture which I impose on you as Haverford 
Alumni, seeking to employ rightly the talent entrusted 
you. Of weapons you have at hand one of the 
keenest edge and finest temper, namely, youth; 
eager, restless, radiant youth, which seldom knows 
defeat and as often counts it victory. Ah the glory 
of youth! May it continue to shed its brightness 
upon you long after, as measured by years, it has 
passed you by, and may you in turn cherish the 
precious boon of being young, this gift of the Gods 
to be valued as such. For 

"God gave you youth, God gave you 
Love, and even God can give no more." 



IV 

SOME CONSIDERATIONS 

PRELIMINARY 



STUDY OF MEDICINE 



Being the Introductory Address to the 124th Annual Session of the 

Medical Department of the University of Pennsylvania, 

delivered October 1st, 1889 



IV 

SOME CONSIDERATIONS PRELIMINARY 
TO THE STUDY OF MEDICINE 1 

It has not been unusual, of late, to disparage the 
introductory address, and there are those who would 
altogether omit it from the curriculum, as unprofit- 
able, and as occupying time which were better spent 
in the regular exercises of the course. But when it 
is remembered that there are collected, on an occasion 
like this, nearly 500 young men, at least one-fourth 
of whom are present for the first time in official re- 
lation with their instructors and most of whom are 
strangers in a great city, it is difficult to conceive why 
an hour may not be profitably employed in the consid- 
eration of matters which may be useful and even impor- 
tant to them. I feel, therefore, that it is not the nature 
of the office so much as the shortcoming of the officer, 
not the introductory lecture, but the introductory 
lecturer, who is responsible if the hour prove un- 
profitable, and that it will be my fa alt, therefore, if 
to-day this should be the case. In turn, I can but 
promise the effort which the choice of my colleagues 
and my wish to serve you demand of me, and it has 
seemed to me that I could perhaps best do so by 
bringing to your notice some considerations which I 
believe are appropriate in this preliminary stage of 
your studies. If, in so doing, I appear at times to 
address more especially those who are here for the 
first time, I must ask the indulgence of the more 
advanced students who are not strangers among us. 

1 Being the Introductory to the 124th Annual Session of the Medical 
Department of the University of Pennsylvania, delivered October 
1st, 1889. Not previously printed. 

63 



64 SELECTED ADDRESSES 

Without attempting to make a comparison between 
the profession of medicine and the other so-called 
learned professions, it goes without saying that the 
occupation whose object is the saving and prolonga- 
tion of life is an important one. The evident corollary 
from this proposition is that the choice of such pro- 
fession should not be lightly made, but that thought- 
ful consideration should be given not only to its im- 
portance and responsibility, but also to the motives 
leading to the selection. Everyone knows that mis- 
takes are made, and that in consequence great dis- 
appointment follows great expectation, while a career 
which might have been useful has been a failure. 
Nor is it always given us to pre-elect the life for which 
we are best fitted, and it may happen that that for 
which we had supposed ourselves adapted, proves 
to be the reverse, and that that for which one seemed 
least fitted turns out to have been his true vocation. 
More frequently, however, a little more knowledge at 
the beginning, a little more looking before leaping, 
would have averted the erroneous choice, and with 
it the chagrin and disappointment of a mistaken 
vocation. 

The first qualification of a student for the profession 
of medicine is a fondness for the calling and an interest 
in it apart from the mere purpose of living by it, and 
especially of growing rich by it. "In other words, 
his heart must be in his work," for "the heart giveth 
grace to every art." It does not harm a doctor to be 
ambitious. Indeed, it is to ambition that we are in- 
debted for some of our greatest and most useful 
physicians; and although it cannot be regarded as the 
noblest incentive to good work, we dare not ignore the 
good that has come out of it. But if ambition is 
unaccompanied by an interest in the science and prac- 
tice of medicine for its own sake, it leads to results 



DISEASE— MEDICAL DELUSIONS 65 

scarcely less serious than the stimulus of money- 
making alone. Again the student whose object is 
simply to make a living by practice is scarcely more 
fortunate. The hours devoted to study instead of 
being given con amove are bestowed grudgingly and 
perfunctorily, and the most serious problem with 
him often is to determine the minimum of work to 
accomplish his purpose. At the end of a year a 
" condition" or two, perhaps, awaits him, which if not 
worked off is carried into the second year, hampering 
his course through it, and when the third year is reached 
he is probably similarly handicapped and coming to 
his final examinations having just disposed of his 
previous year's work. As a consequence, there is 
failure, or he passes with the barest margin. Hav- 
ing obtained his diploma, when consulted he ap- 
proaches his case with indifference, and fails to make 
such study of the disease as is necessary to its thorough 
understanding and successful treatment. This is 
early recognized by patients, his services are not 
further asked, he drifts from his profession a dis- 
appointed man and a failure. 

Far different is it with him whose motive is an 
interest in the science of medicine, whose heart is in 
his work, although he would also live by it. To him 
work for eight, ten or a dozen hours a day is not a 
gruesome task but a pleasurable means to a much- 
desired end; and when the goal is reached the pleasure 
deepens as facilities grow, culminating in the oppor- 
tunities of the hospital ward and autopsy room. 
Thence into the struggle for bread, the same interest 
leads to such understanding of disease and correct 
diagnosis underlie as all successful treatment. Success 
is easy, and thus in medicine as in all occupations: 

"He that followeth love's behest, 
Far exceedeth all the rest." 



66 SELECTED ADDRESSES 

He who adopts the profession of medicine for the 
sake of growing rich thereby, soon discovers his mis- 
take, or in his extreme efforts to succeed is apt to adopt 
methods which lose him the respect of his fellows and 
in the end that of those who employ him. Not that 
one may not make a good living or even lay up some 
money if he thoroughly masters the science and art of 
medicine, attends to his affairs and lives frugally; 
but he who looks to this alone for his compensation is 
sure to be disappointed. There must be something 
more, and he who combines with an interest in the 
study of disease and its cure a pleasure in a useful life, 
has this additional incentive, and in acting under it, 
refines and elevates himself to a position nearer the 
Great Physician, whose life was the highest expression 
of that which we, at best, can but feebly imitate. 

The chief object of your office as physician is, of 
course, to battle successfully with disease; and the 
better to carry out my purpose I desire at this juncture 
to discuss with you briefly the question: "What is 
disease ?" And doubtless some will be disappointed 
in the definition, or rather picture, I shall give you, 
for it is difficult to define disease in a few words. In 
the first place, let me say, disease is not an entity, it is 
not a something which exists of itself inside or outside 
the living body, independent of it. A dead body 
cannot be diseased. In order that it may be diseased 
it must live, but it lives abnormally. Hence Samuels, 
in his text-book on " General Pathology," well says: 
" Kranksein heisst anormal weiter leben" — to be sick 
means to live abnormally; that is, with the functions 
deranged so that what in health goes on unobserved 
becomes noticeable to the sick man as a discomfort, 
so long at least as his sensibilities remain. Thus the 
heart which in health beats its seventy-two strokes 
per minute without awakening the attention of its 



DISEASE— MEDICAL DELUSIONS 67 

owner, when diseased causes great distress. One of 
the most important mechanisms in the human body- 
is the heat-producing and heart-regulating apparatus. 
When all goes well with this, our temperature is kept 
normal, and we are comfortable and unconscious that 
such mechanism exists within us. But let it be de- 
ranged, and the discomforts of the chill and fever are 
its manifestations. Our tissues are filled with sensi- 
tive nerves, of the existence of which we know nothing 
until they are touched or annoyed. But let them be 
irritated, let their function be deranged, and we be- 
come the subjects of exquisite suffering. This is 
disease, and its treatment consists in restoring the 
disordered structure and deranged function to their 
natural state. 

This restoration of the abnormal to the normal, or 
what is known as the "cure" of disease, may be 
spontaneous or it may be artificial, that is, through 
nature's own efforts or brought about by the physi- 
cian's aid. One of the first lessons to be learned by the 
student, and one of the greatest importance, although 
also often a disappointing one, is this, that we possess 
less power to control disease than he had supposed, 
and, further, that as an honest man he dare not claim 
always that although recovery follows the administra- 
tion of his remedies, such recovery is a cure to be 
ascribed to their action. In other words, it is im- 
portant to remember there is a natural or spontaneous 
cure; that disease, and especially acute disease, often 
gets well of itself; that there is an inherent tendency 
in the living organism to throw it off, a tendency which 
was well named by the earlier physicians the " Vis 
medicatrix naturce" which, translated, means simply 
the healing power of nature. Undoubtedly the wisest 
of the earlier physicians were aware of this fact, but 
whether the great majority knew it or not — and let 



68 SELECTED ADDRESSES 

us out of charity suppose they did not — those whom 
they treated were ignorant of this important truth, 
and to a less extent remain so to the present day. 
This ignorance I hold largely responsible for the 
medical delusions under the spell of which so many 
thousands of the good people of to-day are living. 
I believe too, that honest effort, even at the present 
day, to convince people outside of the profession that 
the majority of cases of acute illness, under favorable 
conditions get well of themselves, and that the re- 
covery is the result of nature's own reactive power — 
will do more to advance rational medicine than the 
most laborious studies in materia medica and thera- 
peutics. It does, however, matter in the interest of 
truth that when we order drugs we do so in accordance 
with the results of experience and reliable experiment, 
and in doses which such experience and experiment 
render likely to be efficient, rather than in infinitesimal 
quantities which are every day exceeded in the water we 
drink and the meat we eat. Notwithstanding the 
fact that no one possessing common sense and 
knowing the effect of an ounce of alcohol, would 
expect aught else than a gradually diminishing 
effect from a gradually diminishing dose, we are 
asked by some to believe that to the treatment of 
disease this truth does not apply; and although 
many accept such belief, it is reasonable to suppose that 
the same persons if convinced of nature's power to heal 
would be less likely to ascribe effects to doses which 
their e very-day experience teaches are inert. 

Another factor of great importance in the cure of 
disease, which should be recognized at the outset of 
your career, is the influence of the mind, and I wish I 
had the time to treat it as it deserves, for it 
is a matter of very great importance. By "mind" 
is not meant imagination, although imagination is a 



DISEASE— MEDICAL DELUSIONS 69 

word often used to indicate the same thing. Nor is it 
"faith," although what is called faith works in the 
same way. I have said that on the fact that disease 
tends to get well of itself is based a large part of the 
delusion with regard to its cure under which so many 
really intelligent people live. I might add that to the 
influence of the mind on disease is due the balance of 
such delusion. We have but to look around us to see, 
almost daily, especially with our opportunities as 
physicians, instances of this most remarkable fact. 
But it will be interesting to you to go back a little, in 
time, for illustrations, in order that I may show you 
how certain delusions long since given up were sustained. 
For it takes a good while, often, to destroy a delusion, 
and one dare not too soon decry a treatment lest it 
should prove to have elements of strength which we 
overlook; though it is true, also, that the growth of our 
knowledge in all directions, as well as in that of disease, 
enables us at the present day to refute promptly 
notions which a century ago would have exerted their 
spell for a longer time. 

One of the earliest of the delusions illustrating the 
influence of the mind on cure of disease was the "Royal 
Cure," as it was called, according to which scrofula, 
or the "King's Evil," was quickly dispelled by the 
laying on of royal hands. This was practiced by the 
rulers of England from the time of Edward the Con- 
fessor to Queen Anne. William III discontinued it, but 
Anne resumed it, and among her successful cases was 
the renowned Samuel Johnson. After the laying on 
of the hands a gold coin attached to a white ribbon was 
hung around the neck of the patient. "According to 
the statement of the advocates and contemporaries of 
this remedy," says a writer in the Edinburgh Medical 
and Surgical Journal, 1 "none ever failed of receiving 

1 Vol. Ill, p. 103. 



70 SELECTED ADDRESSES 

benefit unless their little faith and credulity starved 
their merits. Some are said to have been cured im- 
mediately on the very touch, others did not so easily 
get rid of their swelling, until they were touched a 
second time. Several cases are related of persons who 
had been blind for several weeks and months, and 
obliged even to be led to Whitehall, yet recovered their 
sight immediately upon being touched so as to walk 
away without any guide." And listen to this state- 
ment by Wiseman, a distinguished surgical writer of 
the day: "I myself have been a frequent eye-witness 
of many hundred cures performed by his Majesty's 
touch alone, without any assistance of chirurgery; 
and those many of them such as had tried out the 
endeavors of able chirurgeons before they came hither. 
It were endless to recite what I, myself, have seen, and 
what I have received acknowledgments of by letter, 
not only from the several parts of this nation, but also 
from Ireland, Scotland, Jersey, Guernsey. It is 
needless, also, to remember what miracles of this 
nature were performed by the very Bloud of his late 
Majesty of blessed memory, after whose decollation by 
the inhuman barbarity of the regicides, the reliques 
of that were gathered on chips and in handkerchiefs 
by the pious devotees, who could not but think so 
great a suffering in so honorable and pious a cause 
would be attended by an extraordinary assistance of 
God and some more than ordinary miracle; nor did 
their faith deceive them in this their point, being so 
many hundred that found the benefit of it." The 
unfortunate Charles II himself, here alluded to by 
Wiseman, touched nearly 100,000 persons in twelve 
years, and even the Catholic clergy of the day did not 
deny that the power had descended to Protestant 
princes. 

Another of the delusions which illustrate strikingly 



DISEASE— MEDICAL DELUSIONS 71 

the influence of mind over disease is what was known 
as "Perkinism," which held for years a wonderful 
sway, not only in this country, where it originated, 
but also in Europe. In the year 1796 one Dr. Elisha 
Perkins, a respectable practitioner in Norwich, Conn., 
conceived the idea that metallic substances might have 
the effect of removing disease if applied in a certain 
way, and contrived in the course of certain experi- 
ments, his metallic tractors. These consisted of two 
pieces of metal, one of iron and the other of brass, 
about three inches long, blunt at one end and pointed 
at the other. He took out a patent for his invention 
and at once began to travel with a view to spreading 
his practice. The tractors were first applied for the 
cure of such affections as rheumatism, local pain, in- 
flammations and tumors, by drawing them lightly over 
the affected part for about twenty minutes. Numerous 
cures resulted, and Perkinism received many supporters 
of high social standing and influence. In 1798 he 
crossed the Atlantic, going first to Denmark, making a 
public exhibition of their application in the Royal 
Hospital, at Copenhagen, while his son, Benjamin 
Douglas Perkins, carried the tractors to London and 
introduced the practice there. Cure followed cure, 
books were written enumerating them and containing 
testimonials from clergymen, physicians, lords and 
ladies, professors, judges and members of Congress; 
Perkinian institutions were founded, poets sang the 
tractors' praises, and in about six years Douglas 
Perkins returned to America with more than £10,000 
of English money. Notwithstanding all this, by 1811, 
fifteen years after the announcement of the elder Per- 
kins, the tractors were almost forgotten, although a 
million and a half of cures were reported, although at 
one time workmen could not make them fast enough, 
and it was once predicted that in a short time there 



72 SELECTED ADDRESSES 

would be very few private families without them. It 
was soon ascertained by impartial and clear-headed 
observers that tractors made of lead and wood were 
equally efficacious, while nails, pieces of bone, slate 
pencils and tobacco pipes did as well. In illustration 
of which I quote from the essay of Dr. Holmes on this 
subject 1 the case of one Ann Hill, who, having had the 
wooden tractors applied for a pain on the right arm and 
shoulder, said at the end of five minutes: " Bless me, 
why who could have thought it that them little things 
could pull the pain from me. Well, to be sure, the 
longer one lives the more one sees; ah, dear!" 

Similar reputation was acquired by the weapon 
ointment, or unguentum amarium, which was applied 
not to the wound, but to the weapon, the former be- 
ing, however, washed and bandaged; also the tar water 
of Bishop Berkeley, the sympathetic powder and 
numerous other remedies of less wide reputation. 

To come down to the present day we have a strik- 
ing illustration of the effect of mental influence in the 
cure of disease by what is known as the " Faith Cure," 
or Divine healing. According to this doctrine, if I 
understand it rightly after a careful perusal of a 
paper by a believer who says that he has been inti- 
mately associated with the faith-healing movement 
ever since it began to attract public attention in this 
country, 2 it is only necessary for the patient to be- 
lieve that he or she will be healed through Divine 
power in order that he may recover; in other words, to 
have faith. This faith in a patient is regarded as a 
necessary condition, a perfect consecration of the 
whole spirit, soul and body being required, at least 
when the individual is responsible. It is said, how- 
ever, that rare exceptions have occurred in the case 

1 "Homoeopathy and Kindred Delusions." 

2 R. Kelso Carter, The Century, March, 1887, p. 776. 



DISEASE— MEDICAL DELUSIONS 73 

of persons who have not been aware of the prayers 
offered in their behalf. At the same time the " Faith 
Healers' ' believe in the use of means such as prayer, 
the laying on of the hands, anointing of oil, etc., but 
these are regarded as of no efficacy in themselves. 
They must be accompanied by belief. 

Another delusion of modern times is "Christian 
Science' ' healing. So far as I can ascertain from an 
examination of the writings of its advocates, it is but a 
modification of the " faith cure," although its sup- 
porters insist that there are decided differences. Such 
difference, as stated by these supporters, is that the 
healer by Christian Science does not touch the 
patient. There is no " laying on of hands," or 
" speaking the word," the Christian Science healer 
preferring to " speak in silence to the patient's mind," 
whatever that may mean. I cannot but conclude, 
therefore, that while there seem to be more com- 
plexity and systematic effort in the method of the 
Christian Science healer, there is no essential difference 
in the principle of healing. Belief or faith is the 
essential condition in each case. 

Now, what does a fair examination of the so-called 
faith cure and Christian science healing reveal? 
Only that one of two things is true; either it is im- 
possible for persons with organic or structural disease 
to have faith, or faith fails of its purpose. For such 
examination fails to discover a single case of cure which 
bears the scrutiny of scientific analysis, while there 
are very few practical physicians of large experience 
who cannot point to cases of incurable affection 
which have appealed to this method of cure without 
any result whatever, and there are not a few who can 
point to cases which defied the faith cure but re- 
sponded to surgical measures. Almost every day 
brings us instances of such failures. They include 



74 SELECTED ADDRESSES 

cases of morbid growths, consumption, Bright's 
disease, of fever and accidental injury. Some of the 
reports are interesting and even amusing, while others 
are extremely sad. Within a few days I read in the 
columns of a reliable weekly journal the following: 

"Bert Williams, aged 17 years, died in a hospital in 
Findlay, O. He had injured one of his legs while 
playing ball, and a doctor stitched up the wound. 
The stitches were removed by believers in 'faith cure,' 
and the boy was prayed over by them until gangrene 
set in, with fatal result." 

For the benefit of the members of the dental class 
I extract the following from another journal: 

"A Scranton mother whose son had toothache, took 
him to a faith healer. 'Look me in the eyes/ said 
the doctor, fixing a fascinating gaze on the weeping 
youth. 'Now your toothache has entirely dis- 
appeared. You haven't a bit of toothache about you.' 
'You lie, I have,' yelled the boy, with a fresh howl. 
The mother then took him to a dentist." 

Few who have seen the daily papers have failed to 
read within the last ten days of the sad cas^ of Martha 
Olsen, in Brooklyn, a Swedish girl who, confiding in 
the faith cure, refused all other treatment and perished 
of typhoid fever, from which, as attested by the 
autopsy, there is reason to believe she would have re- 
covered under judicious treatment. 

That certain results have followed the efforts of 
the faith healers and Christian science healers I do 
not have the slightest doubt. That these can, how- 
ever, be accounted for by natural causes I am equally 
certain. For in the first place they do not include in- 
stances of structural disease except such as are spon- 
taneously curable. The vast majority of the cases 
so cured are functional, or what is commonly termed 
"nervous," numbers of which are cured by powerful 



DISEASE— MEDICAL DELUSIONS 75 

mental impressions of various kinds, such, for ex- 
ample, as the command of a man or woman possessed 
of strong personality. Few present have not heard 
of cases of chronic nervous disease, especially in 
young women, where recovery has taken place as 
the result of such influence. Such women have arisen 
from their beds, where they have lain for months, 
and walked down-stairs without assistance. Similar 
results have followed other powerful impressions. 
Among other cases related by Dr. J. M. Buckley, in a 
recent article on Faith Healing, 1 is that of a lady who 
had long been ill, was reduced almost to a skeleton, 
and could not even raise a glass of water to her lips. 
This same person on the occasion of her house- being 
afire, sprang from her bed and seized a chest she could 
not have moved without help when in health, and car- 
ried it down-stairs. Many more striking illustra- 
tions of the influence of mental impressions over 
disease could be narrated did time permit, and to 
those who would pursue this subject further I would 
commend a very interesting book by Dr. Daniel 
Hack Tuke, entitled " Illustrations of the Influence of 
the Mind on the Body in Health and Disease." 

Admitting certain effects of the kind named from 
the use of the tractors, the weapon ointment, of mes- 
merism, of the faith cure and Christian science healer, 
how is this brought about? I believe the cases may 
all be placed in one of three categories. First, are 
the cures due to nature, to which I have already said 
must be ascribed the majority of recoveries what- 
ever the treatment, whether by what we are pleased 
to call rational or orthodox methods, or by some one 
of those detailed. Second, are those due to the 
mental impressions already described, and which 
while often permanent are as often found to be tem- 

1 Century Magazine, March, 1887. 



76 SELECTED ADDRESSES 

porary. In this category are to be placed those 
temporary improvements, the result of hope and en- 
couragement, so often described in the words of the 
patient to the cheery doctor: "Your very presence 
makes me feel that I shall get well." Among these, 
too, may be included those fallacious improvements 
so well illustrated in the history of that sad disease, 
tuberculous consumption, when the patient deludes 
himself with the belief that he is getting well, while the 
fell sergeant is hovering near awaiting the favorable 
moment to seize his prey. In the third category are 
to be included those cures which occur in the minds 
of the curer, rather than in the patient, and which 
are well illustrated by the instance of the cured tooth- 
ache just related, and which I am sorry to say some- 
times also have their illustrations in the pretentious 
claims of a few of our own number. 

Thus have I reviewed some of the delusions which 
I feel it is important that you should understand at 
this early stage of your studies in order that you may 
not only explain actual and apparent cures, but that 
you may also enlighten others who through igno- 
rance accept dogmas which require but the light of 
day to explode them. It is needless to say that among 
these delusions I include homoeopathy, curing as 
it does through nature's own efforts, curing through 
carefully regulated diet, curing through mental sug- 
gestion, but not by the direct effect of its remedies, 
when administered according to the organon of Hahne- 
mann, which alone must be considered as constitut- 
ing homoeopathy. From facts coming constantly to 
my ears I am under the impression that by many the 
homoeopathy of Hahnemann is being substituted by 
a judicious eclecticism, which is further adding to the 
reputation of the so-called system, a course of action 
which cannot be regarded as strictly ingenuous. 



DISEASE— MEDICAL DELUSIONS 77 

Those who desire a further refutation of this delusion 
I would refer to the classic essay of Dr. Oliver 
Wendell Holmes, on " Homoeopathy and Kindred 
Delusions." Written nearly fifty years ago, it is as 
fresh and convincing to-day as when first published. 

But is there nothing left for the physician to do 
through his own efforts? Plenty, I assure you, In 
the first place there is a large category of diseases in 
which although nature makes the effort to heal, she 
herself is not adequate to the task, or if adequate 
must accomplish the healing very slowly. The physi- 
cian comes to her aid and supplies the essential con- 
ditions. Sometimes rest alone is the condition re- 
quired, but the patient does not know this, and the 
knowledge of the physician supplies it. This is the 
case, for example, with certain simple fever processes 
and local inflammations. Others more serious are 
accompanied by symptoms which either do not cease 
spontaneously, or, pending the effort of nature to 
eliminate them, life ebbs away. Such are the diar- 
rhoea of typhoid fever and the high temperature of 
the same and other infectious diseases. These the 
physician can directly and successfully combat, and 
thus save life, for which the patient is undoubtedly 
indebted to him. Again there is the great range 
of surgical affections, many of which, like the simple 
scratch and clean cut, if left to themselves, promptly 
heal without further aid. Then there are those like 
the simple abscess, which in time will evacuate 
itself and get well, but the termination of which 
will be accelerated by the surgeon's knife. Others 
more serious are incapable of spontaneous recovery 
under any circumstances. Again, the fractured bone 
left to itself may unite, but with a resulting de- 
formity which makes it useless, while with the sur- 
geon's aid, a well-formed and useful limb results. 



78 SELECTED ADDRESSES 

But the crushed leg of the railway accident and the 
bullet-shattered bone have no such recuperative power, 
requiring the skill of the surgeon for their successful 
treatment, or his knife for their removal. To these 
we must add the extensive domain of internal surges, 
through which, by the aid of aseptic and antiseptic 
measures, the surgeon's progress has been one trium- 
phal march, alongside of which the physician's most 
successful efforts are a subdued pageant. But in 
addition to the good offices I have already assigned to 
him there are a few diseases which may be directly 
and successfully assaulted by his remedies, which 
under these circumstances are called " specifics." 
Such are the malarial fevers, intermittent and re- 
mittent, which yield promptly to quinine properly 
administered. Such are also the secondary and 
tertiary manifestations of syphilis, which yield to 
iodide of potassium and mercurials. 

Nor does it follow that the physician may not avail 
himself of the influence of mind over disease, of which 
I have said so much as the foundation of delusions 
in treatment; in fact, it is almost impossible to elimi- 
nate it from the treatment of many diseases. I have 
alluded to the influence of the physician's own presence 
and manner, and in many other ways which I have 
not time to discuss, this influence makes itself felt. 
But it is making it the basis of a separate system of 
cure-all treatment and palming it off to some other 
cause or agency that I regard as deceptive and un- 
justifiable. Do not fear, therefore, that there will 
not be much for you to do in the direct line of your 
office as healers. In addition an enormous field just 
now being opened up is also before you in what is 
known as preventive medicine, or hygiene. 

The facilities of to-day for the study of all branches 
of medicine are vastly greater than they were when 



DISEASE— MEDICAL DELUSIONS 79 

your instructors were students, and looking back over 
the 25 * years that have elapsed since I was a student, 
comparing my past with your future, I feel that you 
are to be congratulated on being students of medicine 
to-day. I am sure there is no profession the approach 
to which is more interesting; and although its mastery 
is not to be acquired without effort, with your hearts 
in your work, such effort needs to be no greater 
than is wholesome and developing, and if tempered 
with wholesome recreation, you will find your path to 
be one of rare pleasantness and interest. 

1 Now 50 years. 



v 

VALEDICTORY ADDRESS 

TO THE 

GRADUATING CLASSES 

IN 

MEDICINE AND DENTISTRY 

OF THE 

University of Pennsylvania 



VALEDICTORY ADDRESS TO THE GRADU- 
ATING CLASSES IN MEDICINE AND 
DENTISTRY OF THE UNIVERSITY OF 
PENNSYLVANIA 1 

Graduates in Medicine and Dental Surgery: 

Scarce a decade has elapsed since circumstances 
made it my duty to give the parting address to the 
graduating classes in Medicine and Dentistry. Yet 
the nine short years which have carried us from that 
day to this have witnessed so many changes in the 
personnel of your teachers and others who were 
gathered in this Academy on that occasion, that I 
have thought it might interest you if I referred to 
them briefly by way of introduction to what else I 
may have to say. But a few hours ago I had 
written the words, " happily death has dealt gently 
with those who appeared on the roll of professors 
on that day." The ink was scarcely dry on my page 
when came the intelligence that Joseph Leidy was 
seriously ill, and close on this the fact of his death. 
This most unexpected calamity has changed the 
present occasion from one of rejoicing to one of 
mourning — scarcely mitigated by the circumstance 
that Dr. Leidy died as he wished, after a short 
illness and with his shoulder, as it were, still at the 
wheel. For Dr. Leidy never ceased to work. His 
industry was only equalled by his intellect, and these 
by the sweet simplicity of his life. He loved science 
for science's sake, and neither poverty nor promise 
of riches, nor ambition nor princely decoration could 

1 Delivered at Annual Commencement, May 1st, 1891. 

83 



84 SELECTED ADDRESSES 

swerve him from his purpose. We are stupefied by 
the suddenness of our loss. And yet there is a fitness 
in the association of the end of this your greatest 
teacher's life and the new commencement of your 
own, which ought not to be without its effect in 
keeping green his precious memory and in stimu- 
lating you to emulate his example. 

"Quis desiderio sit pudor, aut modus 
Tam cari capitis?" 

Hoeace, Ode xxiv, Book 1. 

Of the others then upon the roll of professors, 
Emeritus Professor Henry H. Smith, a painstaking 
teacher, and surgical writer, ex-Surgeon General of 
his native State, and benefactor of his alma mater, 
had passed the privileged threescore and ten when 
called to his long home. The only other chair which 
has suffered by death is that of Hygiene, and that 
has been signally unfortunate. Dr. Joseph G. 
Richardson, who filled it on that day, was prema- 
turely cut off before he had attained the distinction 
which his ambition sought and his ability promised; 
while his successor, the gifted Randolph, had de- 
livered but a single course of lectures when death 
by accident closed a hopeful career. Dr. Randolph's 
successor, Dr. Samuel G. Dixon, still lives to share 
with Robert Koch whatever fame will attach to the 
discovery of a cure for tuberculosis derived from its 
bacillus. The others who sat about me as colleagues, 
and who are no longer such — the scholarly Stille, 
the eloquent Penrose, the close thinker Harrison 
Allen, and the grand but never old surgeon Agnew, 
still live, leading active, useful lives, examples which 
are worthy of your imitation. Colleagues, too, have 
come and gone since that day. The accomplished 
and sunny Osier, after four years with us was called 



A DECADE IN RETROSPECT— THE FUTURE 85 

to another University, and was soon followed by the 
skilful operator Howard A. Kelly, who served a 
single year as associate professor. 

On that day 117 men received the degree of 
Doctor of Medicine, and 41 that of Doctor of Dental 
Surgery. To follow the career of all of these would 
be impossible, but so far as I have been able to do 
it I have found it intensely interesting. Of the 
medical men nine are dead, one for each year. 
Albert Hosmer Baker, Eliston R. Bateman, George 
W. Kline, Charles R. Matchett, N. Archer Randolph, 
J. Henry Shope, George Hazzard Wattles, Henry 
Wile and Arthur M. Wilson, are sleeping a sleep 
which no night alarm can disturb, or anxious case or 
restless ambition make fretful. Of those who live, 
five are professors in medical schools, one has been 
a professor in our own school, one is the Dean of the 
Medical School of Yale University, one is the Dean 
of the Department of Arts and Sciences and another 
a professor of biology in our own University; three 
are instructors in this school, one is an expert 
microscopist in the service of the United States 
government — a record also exemplary. Of the Dental 
Class, two only are on the roll of the dead, William 
T. White and Jefferson P. Winner. 

What will be the story of us, what the story of 
yourselves in another decade. Happily over this a 
veil is cast, which it were vain to attempt to draw 
aside. Of this much only are we certain, that some 
of us will have joined our brothers in the undis- 
covered country. Already have we had a decisive 
and painful reminder of this certainty. Your col- 
league, Charles W. Van Dyke, was just stepping on 
the threshold of the goal for which you have all 
been so bravely contending, when the enemy which 
he had been preparing to vanquish in others lay 



86 SELECTED ADDRESSES 

claim to him. A bachelor of arts from Prince- 
ton college, a student of such rank and personal 
qualities as made him the choice of his fellows for 
president of one of our undergraduate medical soci- 
eties, and a successful applicant by competitive ex- 
amination for a hospital position, there was every 
reason to believe that Van Dyke had before him a 
promising and successful career. But it was not to 
be. Fortunately the sting is not for him, and our 
sympathies go out rather from classmate and teacher 
alike to the now grief-stricken family, who had been 
gayly looking forward to this particular day as the 
bright commencement of an honored and valued life 
for the son and brother. 

Having drawn from the past the possible lesson 
of the future, which, though in some respects sadden- 
ing, is still wholesome for occasional contemplation, 
let us turn to matters which may be of greater 
personal interest to you. You are this day made 
members of a profession whose business it is to 
avert disease and to help and to heal the sick, and 
this will probably be the occupation of your lives. 
It will, with most of you at least, also, be a means of 
livelihood; to some it will be a road to fortune, to 
some a road to fame; some it will lead to both. It is 
not likely that anything I may have to say at this 
time can greatly contribute to your success in either 
direction. Yet the measure of my inclination is so 
great that I venture to occupy a few minutes in empha- 
sizing some conditions which seem to me essential to 
a right success, by which I mean, briefly, a useful and 
contented life, based upon the acquirement of a reason- 
able degree of professional, financial and social success 
coupled with the respect and confidence of one's 
fellows. And in so doing I shall consider first, your 



A DECADE IN RETROSPECT— THE FUTURE 87 

relations to your patients, second, your relations to 
each other, and third, to the world at large. 

First, as to your immediate professional success, 
the treatment of disease and the satisfaction you will 
give to those who employ you. The first condition 
I enjoin upon you is that you do all things you 
attempt, in the best possible manner. Slight nothing, 
however trivial it may appear. Emerson has told us 
" there is always a best way of doing everything, if 
it be to boil an egg." We need to apply this in our 
every-day life, but its importance is increased when 
its application is extended to business relations. 
Nothing is so soon discovered as that a physician or 
dentist neglects small matters, and nothing is so 
damaging to his interests as to have patients believe 
that their ills are regarded as of little importance. 
But this is, perhaps, secondary to the fact that an 
inexactness or carelessness in minor matters tends 
to the same habit in more important ones, while "he 
that is faithful in a little is faithful also in much." 
To the same import also is the old maxim — 

" Minimum minimum est sed fidelis esse in minimum magnum 
est." 

The application of this rule is so wide that it may 
be said to include most others essential to success. 
But by way of specializing, I would enjoin you also 
to cultivate a method in your work and the employ- 
ment of your time. The chief advantage of such a 
method is that it results in one's being able to do a 
large amount of work with ease and comfort and 
yet permit leisure for study and recreation; while it 
prevents also the confusion and loss of temper as 
well as time which are the inevitable consequences 
of a want of system and the undue haste which 
grows out of it. Of two men otherwise equally 
gifted, that one will be greatly more successful as 



88 SELECTED ADDRESSES 

well as more useful in a community who is methodical 
in the arrangement of his affairs. Such habits 
engender "a repose in energy" which always 
characterizes great power. 

Second, as to your relations towards each other: 
Much thought was expended nearly half a century 
ago by some of the ablest minds in the profession 
you have this day entered, in constructing a set of 
rules which should govern us in our relations to our 
patients, and especially to each other. The result 
was the Code of Ethics of the American Medical 
Association, a modern classic in literature which 
embodies the highest principles of conduct of men 
towards men. You will do well to study it closely, 
and to make it your guide; but you will learn from 
such study that the code of ethics is but an expan- 
sion of a much older and briefer code, "do unto 
others as you would that they should do unto you." 
Than this there can be no safer guide, and if followed 
it will avoid most, if not all the misunderstandings 
which arise among medical men. Such differences, 
everywhere prevalent, are probably more frequent 
and more bitter in the country and in smaller towns 
than in large cities. From some examination of 
the subject, I am inclined to believe that many of 
them are due to groundless suspicions maintained 
by a want of acquaintance between the men con- 
cerned, as the result of which intentions are imper- 
fectly understood, and actions misinterpreted. Such 
suspicions have been shown to be groundless by 
subsequent closer acquaintance. Such closer ac- 
quaintance is favored by associations intended for 
improvement in medical knowledge and especially 
for social intercourse; and it is because intercourse 
of all kinds is more difficult in the country than in 
the city that misunderstandings are more apt to 



A DECADE IN RETROSPECT— THE FUTURE 89 

occur in the former. The offender, who is more 
often sinned against than sinning, may be one who 
is kept away from his fellows by accident, and when 
circumstances have thrown him into the association 
from which he has thus been kept, he is often found 
to be a tiue and honest heart who has simply been 
attending to his own business while ignorantly 
charged with meddling in that of others. I advise 
you therefore to join the county and other medical 
societies of your vicinity, and even at inconvenience 
and sacrifice attend the meetings by which you are 
brought into association with others of your profes- 
sion, and moreover take with allowance anything, 
especially if it be evil, that is said of another. 

A demon against which I warn you with all vehe- 
mence, is jealousy of the success of others. A sacred 
writer has well said that " jealousy is as cruel as the 
grave ;" and the poet that it is "the green-eyed 
monster which doth mock the meat it feeds on." If 
once allowed to enter the human breast, it grows 
until it masters all better feelings. On the other 
hand, to overcome it is quite within the power of 
firm resolution, and each subsequent effort is followed 
by greater success until complete mastery is attained. 
To be able to rejoice in the success of others as well 
as our own, affords the first and most important 
condition of contentment, which, in turn, is an es- 
sential condition of happiness. Further, in seeking 
success and preferment for yourselves leave no 
honorable or proper effort unmade, but having done 
this and having failed, accept the situation and ^waste 
no time in brooding over supposed wrongs and 
indignities. There is no better school for a hopeful 
spirit than disappointment, and a certain amount of 
it is good for each of us. In a professional experi- 
ence of over a quarter of a century 1 I have myself 

1 Now half a century. 



90 SELECTED ADDRESSES 

had my share of disappointments, but I believe I can 
truthfully say that in not one of these do I fail to see 
that what happened was for the best. I sincerely 
hope you may learn to acknowledge this truth early, 
for certainly it is a truth which is recognized sooner 
or later by all who are wise. 

As to your relations with men in general, I think 
I cover the whole ground when I say to you be 
gentlemen always. Of all that has been written 
and said as to what constitutes a gentleman, I like 
best that which we owe to Cardinal Newman, who 
says "it is almost a definition of a gentleman to say 
he is one who never inflicts pain." It matters not 
whether he be rich or poor, lettered or unlettered, 
well dressed or illy clad, he possesses most of that 
which goes to make up a gentleman who will not 
inflict pain. It does not follow from this that you 
need compromise with that which is corrupt or mean 
or contemptible. The pain inflicted in denouncing 
these is as that caused by the surgeon who plucks 
out an offending splinter, or that of the physician 
who, with a sharp blister, allays an inflammation. 

But it is not quite sufficient for a gentleman that 
he should not inflict pain. A gentleman is also 
sincere, speaks the truth, pays his debts and requites 
all his obligations to men and women. I am not 
one of those who would encourage the feeling that 
it is undesirable to be under obligations to another. 
Were we all to act upon this doctrine we would 
blot out one of the richest well springs of human 
pleasure as well as potent aids to good will, generosity, 
and unselfishness. Mutual obligation is elevating, 
christianizing. And although the obligation should 
be mutual, the return need not be in kind. There 
may be such appreciation and ampleness of gratitude 



A DECADE IN RETROSPECT— THE FUTURE 91 

tempered by good taste and delicacy, as will more 
than requite a thousand substantial favors. On the 
other hand obligations should not be indiscriminately 
incurred, and there are those to whom it is undesir- 
able to be under obligation, those who grant grudg- 
ingly and who expect and even demand a correspond- 
ing return. Unfortunately we have sometimes to 
learn by experience who these are. 

I have said a gentleman always pays his debts. 
A few words about debt — financial debt I mean, of 
course. No burden is more oppressive, none more 
hampers that independence which is so essential to 
the unrestrained exercise of one's abilities, than 
indiscriminate debt. At the same time it is not 
always wrong to borrow. The world would be 
many centuries behind its present stage of advance- 
ment if it were not for the power to make loans. 
Enterprises of all kinds would be baffled at the 
outset, and we would probably still be using the 
most primitive methods of transit instead of the 
" lightning express" and the ocean "flyer," while 
the relations of electricity to man would be limited 
to the destruction of the rude dwelling to which 
the same restriction of enterprise would have con- 
fined him. To borrow, therefore, for the purpose of 
supplying yourselves with a cheaper home, or the 
means of more successfully practicing your art, 
might be legitimate, while to borrow for the sake of 
securing a transient pleasure would be a crime. 

I would advise, also, that you attempt early to 
save something of your earnings, however little. 
No sounder doctrine was ever preached than that of 
dear Mr. Micawber, albeit he did not live up to it. 
While it is true that the pursuit of money for the 
sake of hoarding it or using it improperly is debas- 
ing, it is also true that money gives independence, 



92 SELECTED ADDRESSES 

and independence gives power. I would not, there- 
fore, discourage you from attempting to secure the 
independence which money gives, and which I have 
already said is necessary to the best exercise of 
one's abilities. 

I have referred to an attribute of the gentleman 
which I fear is not as much appreciated at the 
present day as it should be, and I desire much 
to impress you with its importance and value. I 
refer to sincerity. I hope I am in error, but I am 
possessed with the idea that the present day is more 
than usually one of insincerity. Women greet each 
other with effusive expressions of affection, and no 
sooner do they turn away then they begin to dissect 
each other with such exquisite fineness as the 
anatomist rarely exhibits with his scalpel. Men 
address each other familiarly as Tom and Jerry, and 
as soon as separated, malignantly paint each other's 
faults and deficiencies. Young girls quickly learn 
the practices of their mothers and elder sisters. 
Boys, I am glad to say, do somewhat better, for a 
time. They give the lie, return blow for blow, 
sulk for awhile, but soon come together again as 
good friends as ever, and the merry mischief goes 
on as before. With the lapse of years, however, 
comes to them also the effect of association, and the 
boy in this respect is not father to the man. At the 
same time the very men and women who are them- 
selves insincere respect those who are, and trust 
them. Especially is it important that a physician 
should be honest and true, and guard with religious 
care the confidences which are placed in him. Such 
a one may not be immediately discovered and appre- 
ciated, but is, sooner or later, securing then a lasting 
success, while the temporary popularity of his more 
plausible rival grows gradually less. 



A DECADE IN RETROSPECT— THE FUTURE 93 

But I have prolonged my remarks beyond my 
intention and perhaps beyond your patience. My 
excuse must be that already given, viz., a strong 
desire to contribute even a little toward what may 
smooth your way through a world which offers a 
full meed of success and wholesome pleasure to 
those who deserve them and know where and how 
to look for them. In these wishes my colleagues 
join me in a word, simple and familiar, yet so com- 
prehensive as to cover all and even more than I 
have said — 

Farewell. 



VI 
THE GENERAL PRACTITIONER 



VI 

THE GENERAL PRACTITIONER. 1 

At the outset we are met with the question, "What 
constitutes a general practitioner?" Clearly in the 
broadest sense, he is one who shrinks from no service 
which belongs to his art. He is at once physician, 
surgeon, obstetrician, gynecologist, ophthalmologist; 
in a word, anything which has received a title in the 
differentiation of professional work. Yet it is evident 
that it is not possible for any one man to fulfil the 
requirements of all these offices as extended by modern 
medical science and art. Very different was it a 
hundred years ago. Then one could do quite all that 
could be expected of him. Even at that date the 
larger cities contained men who were especially dis- 
tinguished for operative skill who did little else but 
surgery. Such in their day were Sir Astley Cooper and 
Sir Benjamin Brodie. Yet the entire field of medicine 
was reasonably considered as within the province of one 
man. It is evident, therefore, that some latitude 
must be allowed in defining the duties of a general 
practitioner of to-day. Casting about us for the field 
actually filled by him, we find he is one who practises 
first of all medicine in its broadest sense, including not 
only the diseases of children, but also skin diseases. 
He practises midwifery. In surgery he, for the most 
part, limits himself to minor surgery, while he is 
repeatedly called upon to prescribe for the simpler 
affections of the eye and ear. The more complicated 
technic which modern medicine has imposed upon the 
proper treatment of diseases of the nose and throat 

1 An address delivered at the Eightieth Anniversary of the Founding 
of the Gloucester County (New Jersey) Medical Society, September 
15, 1898 and reprinted from the Medical News, Oct. 22, 1S9S. 
7 97 



98 SELECTED ADDRESSES 

demands vastly more time and trouble than the older 
treatment of these affections, and yet the general 
practitioner cannot escape it if he would retain his 
practice, though in the cities this department is largely 
becoming an exclusive province. It is more than 
likely, however, that time will simplify the treatment 
demanded by these diseases. From the surgery 
possible to the general practitioner orthopedics is 
practically excluded, while genito-urinary affections 
necessarily fall within his province. As intimated, in 
the cities the major operations of general surgery are 
practically withdrawn, but in the country this cannot 
be so, else must life often be sacrificed. The same is 
true of major surgical operations now placed in the 
department of gynecology. Hence the term " general 
practitioner" must include more in the country than it 
does in the city. The general practitioner of the city 
is more limited in his work, as much by the will of the 
patient as by his own selection. 

To sum up, then, the general practitioner of the 
present day is, in point of fact, a man who practises 
all the departments of medicine as distinguished 
f from surgery; who practises midwifery, surgery and 
gynecology, except the major operations demanded by 
the last two, and who treats also the minor affections 
of the eye and ear. While this is practically true of the 
general practitioner of the city, the field must be 
extended in the country to include all operations, delay 
in which is dangerous to life. And it is the general 
practitioner in the country, I take it, you have in mind 
when you ask me to treat the subject. It is in the 
country only, in fact, that the general practitioner in 
the truest sense can be met, so that in a word the 
general practitioner is the country practitioner. As 
such, I am inclined to think, too, that the correction 
of the simple defects in refraction, and the prescription 



THE GENERAL PRACTITIONER 99 

of glasses should fall to his lot. I see no reason, at 
least, why he should be excluded from this source of 
revenue. Thus it will be seen that, view it as we may, 
the field of the general practitioner is a broad one. 

Having described the field of the general practi- 
tioner, we naturally come to consider his qualifica- 
tions, and it may be that I will surprise you somewhat 
in what I shall include among these. A moment's 
reversion, however, to the numerous duties I have 
assigned him will make it evident that his attainments, 
to be commensurate, should be correspondingly broad. 
I have more in mind, too, than that his qualifications 
shall simply fit him for these duties, remembering 
that the object of life is something more than the 
simple fulfilment of duty, and that health, happiness, 
and enjoyment are a heritage to which the physician 
is as much entitled as other men. To this end I 
consider that the general practitioner should have the 
broadest preliminary culture attainable. Much more 
than the specialist would I clothe him with a broad 
general culture. I would have him college-bred or the 
equivalent of college-bred. I would have him able 
to at least read Latin, French, and German, while if 
he chose to include in his preliminary education the 
now much-despised Greek, I should regard him as no 
less fitted to fill the important role I have set for him. 
I would have him well drilled in physics no less than in 
chemistry, for no one is qualified to understand the 
problems of physical diagnosis, as set by diseases of the 
circulatory and respiratory systems without a thorough 
knowledge of acoustics and hydrostatics, while with 
such knowledge their understanding is comparatively 
easy. Equally, too, would I have him versed in the 
natural sciences — botany, mineralogy, comparative 
anatomy, and zoology — a biologist in the broadest 
sense of the term; for through such attainments I 



100 SELECTED ADDRESSES 

expect to add to his pleasure as well as to his useful- 
ness, to make his otherwise lonely drives and walks 
holiday excursions pleasurable and profitable. I 
would have him well-read in the standard literature 
of his own and foreign languages, the latter not 
necessarily in the original, but in the excellent trans- 
lations which abound; for I acknowledge that the 
general practitioner has a limit to his capacity for 
attaining and remembering. On the other hand, I 
insist the more on his acquiring such knowledge 
before beginning practice, because, though he still 
may have time to enjoy it after entering professional 
life, he may not have time to acquire it. In a word, I 
would have him equipped with all that will make him 
accomplished, ready, and versatile, with a view to his 
own pleasure and enjoyment, as well that he may 
appear the equal and even the superior of those with 
whom he mingles socially and professionally. He 
should be at least the intellectual equal of the most 
intellectual of his community, the man to whom young 
and old alike will go for information on subjects on 
which they are in doubt, as well as for treatment of 
their physical ills. 

On the details of his professional education I need 
not dwell long, for it goes without saying that he 
should have the best his money can obtain. Nay 
more, if he has not enough money to obtain the best 
let him defer it until he can raise more, if money be 
the measure of its quality. For a cheap medical 
education is like a cheap garment: it may serve its 
purpose for a short time, but it soon needs repairs, 
the ultimate cost of which will far exceed that of a 
good one, while it is an ever-growing disappointment 
to its possessor. No medical man needs a broad 
and thorough medical training so much as the general 
practitioner, for no one has such varied demands 



THE GENERAL PRACTITIONER 101 

upon him, no one is so constantly thrown on his own 
resources. To this end hospital residence in a gen- 
eral hospital for a year at least after graduation should 
be secured when possible. He should be, familiar 
with the use of instruments of precision, such as the 
microscope, ophthalmoscope, apparatus for the ex- 
amination of the blood and the testing of the urine, as 
well as with the stethoscope and laryngoscope. 

We are now ready to locate the general practi- 
tioner. Equipped as he has been, he may locate in 
any community he chooses without fear that he will 
appear at a disadvantage compared with other citizeDS 
of the same town. We will not follow him in the 
selection of his home, for this is a personality with 
which we have no concern. His consulting-room 
should, however, be well appointed with all that will 
facilitate the examination of patients and the study of 
disease. A small apartment, or in the absence of this, 
a corner of his consulting-room, should be fitted up as 
a laboratory with the instruments of research and 
accurate investigation referred to, as well as necessary 
reagents for such chemical and chemico-microscopical 
work as he will be called upon to do. Such an outfit is 
neither large nor expensive, and it is indispensable. 
A man is much more apt to study a case thoroughly 
if he is provided with suitable appliances. These 
should be kept in perfect order, and so placed that no 
time is lost in getting them for use. 

The general practitioner should not long defer 
marriage. Indeed, to be happily wedded seems al- 
most indispensable to his highest success. And he, 
of all men, needs a neat, bright, quick-witted, intelli- 
gent wife. No one but he who has one knows what a 
treasure such a wife is. Simple beauty of person is 
something to which one soon grows accustomed. 
The homely adage that " beauty is only skin deep" is 



102 SELECTED ADDRESSES 

full of meaning, and the qualities referred to make the 
possessor dearer every year that elapses. There is 
nothing that such a wife cannot do. Besides being 
a cheerful helpmate and loving companion, she will 
keep our general practitioner's books and help him 
with his cases, which he will talk over with her, but 
which she will regard as sacredly confidential. Nay 
more, she can learn to test urine and even to use 
the microscope, and otherwise help even more than 
a qualified assistant, because she is actuated by love 
and a common interest, attributes scarcely to be ex- 
pected in a paid assistant. On the other hand, 
nothing is such a drawback to the general practi- 
tioner, the man whose work calls him into so many 
channels, as a careless, slouchy, novel-reading wife. 
I have known more than one man's life blighted be- 
cause he was handicapped by such a companion. 
Nor need he long defer his marriage if the woman 
is of the right kind. To marry on nothing is most 
ill-advised, and I subscribe heartily to the old Greek 
maxim, "How thrice is he unhappy who marries 
poor." But the physician who waits until ample 
means are accumulated before he marries loses the 
best part of married life, the part to which he will 
look back with greatest satisfaction in after years 
of comparative ease and disembarrassment. As soon, 
then, as he begins to see his way clear to reasonable 
success, he should marry a sensible, well-educated 
woman, a little younger than himself. 

We now have our general practitioner well educated, 
thoroughly trained, and well equipped. How shall he 
attain what is called success? We will not stop to 
discuss what constitutes success, except to say that it 
consists neither in wealth nor in power, nor even in 
health, but in a certain proportion of each of these, 
fortified by a consciousness of rectitude and the deter- 



THE GENERAL PRACTITIONER 103 

mination to be content with the results of effort as 
well directed as he knows how. Then as to what con- 
stitutes well-directed effort, no effort of the physician is 
well directed unless governed by the spirit of the 
Hippocratic oath: that he will do his best for his 
patient and sacredly guard the confidences placed in 
him. We will not ask him to take the oath, for we 
are of a profession that is above oaths, holding that an 
obligation is as binding without it as with it, and that 
it does not add to the force of such obligation. 

We may, however, continue our subject by pointing 
out some of the methods which judgment and experi- 
ence have shown to be well directed. First, the 
general practitioner should establish an office or con- 
sulting hour at home and punctiliously maintain it. 
The office hour is often too much ignored by the 
general practitioner, and especially by the country 
practitioner, to whom my mind constantly reverts as 
the true type of the general practitioner. The most 
important requirement of an office hour is that it shall 
be kept. It does not much matter at what time of 
day it is, so that it is rigidly observed. It is soon 
found out and greatly appreciated. Doubtless in the 
country, the evening is more convenient to the patient, 
but it is important for the success of the office hour 
that the physician should be fresh and well rested, 
else the duties of the hour become irksome and are 
unspiritedly and carelessly performed. Hence the 
morning is, on the whole, the most suitable — say 
until nine o'clock or half-past — for your general 
practitioner must be an early riser as his patients are 
also likely to be. Then, after his office hours he will 
still have a long day before him, all of which he will 
need in order to fill the important and busy role we 
have mapped out for him. 

More time still will be gained by a systematic 



104 SELECTED ADDRESSES 

arrangement of work. The busier one is the more 
important this is. I am certain that at times the 
general practitioner is too indifferent to this and loses 
much time in consequence. With an office hour termi- 
nating at 9, or at the latest 9.30, he should start 
promptly on his tour of visits, giving enough time, 
but not more than enough, to each patient. Many 
practitioners make their visits too long and not only 
thus lose time, but diminish the respect of their 
patients for them. Every physician should consider 
his time valuable, as it really is, because there is always 
more to do in various directions connected with his 
present and future usefulness than can be accom- 
plished in a day. He need not, indeed should not, 
indicate by his manner that he is in a hurry; this is 
harmful to his interests. On the other hand, he should 
not loiter, especially should not gossip; for however 
entertaining or pleasing this may be to the patient, it 
will not increase the respect of the latter for him, and 
may even jeopardize the estimation of his counsel. 
One of the best pieces of advice I ever had given to 
me before I began practice, was that of a very dear 
friend, a lady, who said to me one day, " Doctor, when 
you begin to practise, do not make your visits too 
long." She had evidently suffered from the long- 
drawn-out visits of her doctor. She was a great con- 
trast to a patient, also a woman, of a busy friend, 
who said when he manifested some uneasiness at her 
prolonged call, "Why, Doctor, you seem to want to 
hurry me off. My own doctor keeps six horses and 
he stays an hour at each visit." Further comment is 
unnecessary. 

With work welt arranged and no time lost on need- 
lessly prolonged visits, a surprising amount of time 
will be found remaining over after the daily round is 
made. The leisure thus obtained should be spent 



THE GENERAL PRACTITIONER 105 

first in clearing up doubtful points in cases by the study 
of well-selected text-books and current medical litera- 
ture — his journals. It is surprising how often the 
attentive reader of journals finds in their pages cases 
corresponding to his own which will help him to clear 
them up and often to treat them. On this account the 
general practitioner should subscribe to at least one 
first-class weekly medical journal, still better for two 
published in different cities; though it will be more 
profitable to read one such journal well than to have 
two and read neither. It will do him no harm also 
to subscribe for a journal with a more general 
scientific purpose, such as Nature or The Popular 
Science Monthly. This he may have to skim over, 
but it will still help to keep him interested in natural 
science. His journals are the means by which he is 
to be kept in touch with the latest additions to his 
art and science. One or two magazines devoted to 
general literature should be found on his table, to say 
nothing of a good modern newspaper, of which a good 
abstract of daily news and good editorials should be a 
feature; for I have already said that our general practi- 
tioner will have no time to waste on diffuse and volumi- 
nous accounts of events which are contradicted the 
next day. Abstracts and first-class editorials are 
what he wants, the latter to be read in the evening if 
time permits, the former for a few minutes in the 
morning. 

To proceed with our methods, next, or perhaps first, 
he should make a brief note of at least the important 
cases seen during the day as far as they may require 
it. I believe there is no single piece of systematic 
work which is as useful to the general practitioner as 
note taking of this kind. It may be said that this is 
impossible, but it is not. I do not refer to noting 
office cases, for this is easy. Practice in such noting 



106 SELECTED ADDRESSES 

soon leads to a brevity which greatly facilitates it, 
and here the loving wife may lend a helping hand, to 
be replaced by the stenographer as business grows 
and family cares demand the wife's attention else- 
where. Fortunate is the physician who happens to be 
a stenographer himself. Much time and space are 
saved by this accomplishment. One of the most 
interesting and valuable lectures I ever listened to 
was by a busy physician who had adopted the method 
of note taking recommended, not by shorthand, but in 
the ordinary way. The address was based entirely on 
notes of cases in private practice taken from the daily 
note-book to which a few minutes each evening were 
devoted. Whether such notes are employed for any 
future purpose or not, the practice is invaluable, lead- 
ing to systematic arrangement of fact and thought, 
and developing accuracy of observation which reacts 
again and again to the direct advantage and usefulness 
of the one who employs it. 

Nor should he omit to spend a few minutes as 
opportunity offers on current secular literature. A 
volume should always be at hand which can be taken 
up when a few minutes of leisure are present. Some 
one of the numerous inexpensive critical reviews 
treating of current literature and containing abstracts 
of the books of the month should be one of the maga- 
zines referred to as useful. By means of this he can 
keep himself informed of what is going on in literature 
and select the volume to which he is to devote the few 
odd moments which are always turning up. A 
volume of poems from an author cast according to 
the mold of his own taste may be such a volume or be 
one of two or three which may be at hand to be picked 
up at such times. 

Emphatically our general practitioner should be a 
member of the local medical society and should attend 



THE GENERAL PRACTITIONER 107 

all its meetings, at first as a listener. For before any- 
thing else he wants to win the regard of his fellow 
practitioners, and he is almost sure to obtain the 
opposite if he is too ready to seize every opportunity 
to ventilate his views, which are apt to be regarded as 
fresh and crude even if they are not. Gradually, as 
he becomes known by his regular attendance and close 
attention, he may rise to ask a question or add a few 
apposite words, increasing their number until he is 
able to add something from his own experience or 
even from some other source bearing on the subject. 
Then he may report an interesting case and ask the 
views of his fellow members on the subject, and present 
his own, always modestly and without pretension. 
Then he will soon come to be a welcome visitor, and 
later will be wanted to act as Secretary and receive 
other evidences of the good-will and confidence of his 
fellow practitioners, which will go to make up the sum 
of his happiness. 

The State and national societies will also claim 
his membership in due time and it will serve to rub 
off the cobwebs and keep his mind bright to take 
advantage of an opportunity of renewing old friend- 
ships and mingling with professional friends as well 
as to listen to papers and discussions. I am not 
certain that it should be his ambition to attend these 
latter meetings very early in his career. It will be 
at least graceful to offer to look after the work of his 
older confrere while he takes a run to the more distant 
place of meeting. 

But the medical society is not the only place in 
which he will be brought into contact with profes- 
sional friends. He will meet them on the road and 
in consultation, and under all circumstances let his 
greeting be cordial and his welcome frank and sincere. 
Jealousies between doctors are the most unjustified 



108 SELECTED ADDRESSES 

of jealousies, and yet they are said to be very fre- 
quent, especially in the country. I am certain that 
more than half of these are without foundation, the 
result of misunderstanding, misrepresentation, hear- 
say, and the want of acquaintance. And in the 
matter of consultation let me give you a word of 
advice — I say you for I believe that most of my 
audience are general practitioners: Do not be too 
much in a hurry to call in the consultant from the 
city. First call upon your neighbor and exhaust the 
local resources before you send for the specialist 
from town. You may accomplish as much for your 
patient, while you will cultivate good feeling and 
friendship which will react favorably on yourself. 

The first duty of the general practitioner is to his 
patient, but his duty does not end here. He has 
obligations to the community also in which he lives. 
My general practitioner, or the one whose picture I 
am endeavoring to draw, has been educated above 
the level of the majority of the laity with whom he 
associates. He has been educated in a direction 
which gives him knowledge how to guard the health 
of the community. He should, therefore, take an 
interest in what concerns it. He should be on the 
alert to detect violations of hygienic laws, should 
call attention to such violations and suggest measures 
for their correction, as well as be ready to advise on 
matters connected with public hygiene. He should 
do this in a simple, dignified manner, not ostenta- 
tiously or with a desire to exploit himself. It is by 
attention to these collateral matters so intimately 
associated with the interests of his patients that he 
rises above the routinism which hinders his develop- 
ment and prevents his taking the position he deserves 
among the leaders in his community. 

Is the general practitioner to be denied oppor- 



THE GENERAL PRACTITIONER 109 

tunities of social intercourse? By no means. The 
attainments with which we have equipped him espe- 
cially adapt him for his social relations, and we have 
seen that it is partly that he may appear at advantage, 
socially, that we have so equipped him. He will, 
however, be somewhat limited in this respect. His 
time is too valuable. I do not see why the general 
practitioner should not stop for a few minutes in 
passing the house of a patient for afternoon tea. 
It will refresh him and brighten him. The same may 
be said of the evening reception. A prolonged stay 
at either function he can scarcely afford. 

What are the compensations of the general prac- 
titioner? The answer to this question depends some- 
what upon what meaning is put on the word " com- 
pensation." If it means money return, then must he 
often be disappointed, for it is generally conceded 
that the general practitioner is often poorly paid 
in money. If, however, he is willing to take as a 
part of his reward the pleasant consciousness of 
well-doing his pay is commensurate with his good 
work. To hold an honorable position in the com- 
munity and to be looked up to is a privilege for 
which many would gladly give money, but position 
such as falls to our ideal is not to be bought. It is 
only to be obtained from the vantage-ground of the 
qualifications of the thoroughly educated physician, 
imbued with the feeling that his calling is a lofty one 
and that in its unselfish exercise he is approaching 
a step nearer that estate which has caused him to 
be compared many times to the gods of heathen 
mythology as well as to Him who is called the " Great 
Physician." 

The conception I have endeavored to present to 
you may be called visionary and difficult of realiza- 
tion. I admit that it is a high ideal, and that it may 



110 SELECTED ADDRESSES 

not be attained by each and every one. It may, 
nevertheless, be the aim of all, and that it is not 
unattainable is proved by numerous instances. Per- 
haps the highest exemplification of what I desire to 
be aimed at was Sir Thomas Brown, the author of 
"Religio Medici/ ' Sir Thomas was a country prac- 
titioner in the strictest sense of the term, and lived 
in the first three-quarters of the seventeenth cen- 
tury (1605-1682), during fifty years of which he 
practised in the town of Norwich, England, and by 
his literary productions, of which "Religio Medici' ' 
is the most important, exhibited literary attainments 
equal to the highest of his day. These in no way 
interfered with his practice, which was very exten- 
sive, and many persons came from a great distance 
to consult him. The Rev. Mr. Whitefoot, his intimate 
friend for thirty years, wrote of him, "He was par- 
simonious in nothing but his time, whereof he made 
as much improvement with as little loss as any man 
in it; when he had any to spare from his drudging 
practice, he was scarce patient of any diversion from 
his studies; so impatient of sloth and idleness that 
he would say he could not do nothing/' Note that 
his practice was characterized as "drudging," yet he 
understood most of the European languages, the 
Latin and Greek critically. "He was so curious a 
botanist that beside the specifical distinctions he 
made nice and elaborate observations, equally useful 
as entertaining." In other respects he fulfilled our 
ideal of the general practitioner. He left a com- 
fortable, but no great estate to his wife and children, 
acquired by his own industry. He showed also that 
even at that early day the medical education had the 
same liberalizing effect on religious thought that it 
has to-day, in witness of which, let me read the fol- 
lowing extract from his writings: "Nor must a few 



THE GENERAL PRACTITIONER 111 

differences more remarkable in the eyes of man 
than, perhaps, in the judgment of God, excommuni- 
cate from heaven one another. Take our opinions 
together and from the confusion thereof there will 
be no such thing as salvation; for first the Church 
of Rome condemneth us, we likewise them; the 
Sub-reformists and sectaries sentence the doctrine 
of our Church as damnable; the atomist or familist 
reprobates all these, and all of these them again. 
Thus we go to heaven against each other's wills, 
conceits, and opinions, and with as much uncharity 
as ignorance do err, I fear, in points not only of our 
own, but of one another's salvation." These are 
but a few of the many attainments of this truly great 
man. For a further account of him I commend to 
you one of several excellent biographies which are 
extant. His life and writings should be familiar to 
every medical man. 

Nor does the novelist fail to paint us good pictures 
of the general practitioner. To say nothing of the 
oft-quoted Lydgate in George Eliot's " Middle-march," 
we have a picture by Sarah Grand in the " Heavenly 
Twins" of Dr. Galbraith, who, though referred to by 
the author as a specialist, was really a general prac- 
titioner of the type we admire; and the book will 
repay the medical reader from this standpoint. 
Elizabeth Stuart Phelps Ward has given us in Dr. 
Zay an admirable type of the woman general prac- 
titioner, albeit she was a homeopath. She was pos- 
sessed of all the accomplishments and all of the 
noble qualities which go to make up our ideal, and 
her work was full of the nobility of purpose and the 
happy results which fall to it. 

In all word pictures of the physician by lay authors 
we meet incongruities and errors which fall unpleas- 
antly on the ear of the educated medical reader, but 



112 SELECTED ADDRESSES 

this must be so long as the author is not himself a 
medical man; and until the latter, at the same time 
a skilled novelist, furnishes the ideal one, we will be 
dissatisfied with the physician in the novel. Lydgate 
is, perhaps, the best, but scarcely better than Dr. 
MacLure of Drumtochty, as depicted by Ian Mac- 
Laren in his beautiful and touching story, " Beside 
the Bonnie Brier Bush," and no discourse on the 
subject of the general practitioner is complete with- 
out a reference to it. Weelum MacLure accords 
well with our ideal of the general practitioner, having 
been " chest-doctor and doctor for every other organ 
as well, accoucheur and surgeon, oculist and aurist, 
dentist, and chloroformist, chemist and druggist." I 
believe the story of this "scarred veteran in the 
service of his patients," this self -forgetful doctor, will 
do more to lift up the heart of the physician than 
the creation of any other novelist. This may be 
because, as Dr. Watson informs us, "the character 
was not a fiction, but based upon the knowledge of 
four country doctors, either one of whom might have 
sat for his hero." What a privilege to be a member 
of a profession in which such men abound! what an 
honor to be one of those from whom such a type is 
drawn! Well may we glow with pride at the uni- 
versal recognition it has received, and while taking 
new courage from the contemplation of such a life, 
let us not fail also to allow our hearts to be softened 
by his example and bear with patience the many 
disappointments and annoyances that beset our 
daily path. 



VII 
HOSPITAL ORGANIZATION 



VII 
HOSPITAL ORGANIZATION 1 

It is impossible at the present day to consider the 
subject of hospital organization from any single stand- 
point. It may be said that all hospitals have for 
their object the treatment of the sick, but it dare no 
longer be said that this is their only purpose. The 
training of physicians and nurses has of late become an 
acknowledged object, but the amount of this training, 
and the method by which it is carried out, must vary 
with circumstances. Thus, where a hospital has been 
organized as a part of a medical school, it is evident 
that the medical and surgical staff must include, ex 
officio, a certain number of teachers in such school, 
while the thoroughness with which the patients are 
used for teaching is much greater. If, on the other 
hand, the hospital has no relation with a medical 
college, while it may include on its staff medical 
teachers, there is no reason why the staff should be 
drawn from such teachers only. There is evident 
reason why it should include others, since the medical 
and surgical treatment of the sick in not limited to 
professors in medical colleges. The advantages of 
hospital experience should, therefore, not be limited 
to the medical professor. Especially is this true of 
city hospitals supported by taxation. 

From whatever source the physicians and surgeons 
of a hospital are drawn, the teaching of students and 
nurses, should, when possible, be made a part of its 
purpose. It is indeed rare to find so far-seeing a 
man as the late Johns Hopkins, who provided that the 

1 An address before the Hennepin County Medical Society, 
Minneapolis, April 4, 1904. Reprinted from the N. Western Lancet, 
April 15, 1904. 

115 



116 SELECTED ADDRESSES 

hospital he endowed so munificently should be an 
instrument for training physicians and nurses, as 
well as an institution for the treatment of the sick. 
Listen to the emphatic injunctions of his letter to the 
trustees : 

"In all your arrangements in relation to this 
hospital, you will bear constantly in mind that it is my 
wish and purpose that the institution shall ultimately 
form a part of the medical school of that university 
for which I have made ample provision by my will." 
Again: "I desire you to establish, in connection with 
the hospital, a training-school for female nurses. 
This provision will secure the services of women compe- 
tent to care for the sick in the hospital wards, and will 
enable you to benefit the whole community by sup- 
plying it with a class of trained and experienced 
nurses." 

On the other hand, it requires no argument to 
prove that hospital wards, through the number and 
variety of diseases represented in them, furnish the 
best facilities for a practical medical education. I 
am sorry there still remain a few good citizens who are 
opposed to the use of hospital patients for teaching 
purposes, fearing that some harm may come to them 
when thus used. So far from this being the case, I 
venture to say that such patients have an advantage 
over others not so used. This advantage lies in the 
closer study put upon them by the visiting physicians 
and surgeons, and the more thorough knowledge of the 
case thus resulting. I can speak from personal 
experience under both conditions — that of the visiting 
physician teaching from his cases, and of one who does 
not thus teach, and I am sure that, with the strongest 
desire to do my duty, my cases used for teaching re- 
ceive a closer study than those not so used. I 
believe this to be the experience of most conscientious 



HOSPITAL ORGANIZATION 117 

hospital physicians. In confirmation, let me quote 
also from an eminent and experienced hospital super- 
intendent whose authority is acknowledged throughout 
this continent. 1 "The best method of keeping the 
torch of knowledge lighted is to pass it along from 
hand to hand. Hence I have little sympathy with 
those who deplore the use of hospital wards as means 
of instruction. They should be used for the training 
of nurses and for the instruction of medical students, 
and by their very use for these purposes their efficiency 
for the cure of disease will be augmented. " Nay, more, 
the use of this material should no be limited to the 
living patient. It is well known that the examination 
after death often furnishes more abundant and accurate 
knowledge than the study of disease before death. 
Much difficulty is often experienced in securing consent 
for a post-morten examination from the friends of 
even those who have received most liberally of the 
bounty of the hospital and the laborious care of its 
physicians. Had I the authority, I would require the 
nearest relative or friend of every free patient to sign 
a paper agreeing to the making of an autopsy in the 
event of the patient's death. In one hospital in 
Philadelphia this is done, and no difficulty as a rule is 
experienced in securing consent. 

Hospitals cannot be built, equipped, and conducted 
without money. The source of the needed money is 
the voluntary contributor or, in the case of the City 
Hospital, the municipal authority. The hospital 
supported by voluntary contribution is by far the most 
interesting and efficient because its organization is 
more independent of political influence, which is too 

1 From an address before the Training-School for Nurses at the 
Hospital of the University of Pennsylvania, February 17, 1S97, by 
Dr. Henry M. Hurd, Superintendent of the Johns Hopkins Hospital. 
Baltimore. 



118 SELECTED ADDRESSES 

often characterized by a changing and feeble manage- 
ment. Almost without exception the hospital sup- 
ported by voluntary contributions is governed by. a 
board of managers or trustees, as they may prefer to be 
called. This board constitutes the responsible body 
with whom rests the burden of raising money for the 
support of the hospital, the administration of its 
affairs, the determination of the number of patients 
it can treat, and, in most cases, the selection of its 
staff. Whether the contributors be organized or not, 
they become the natural source of selection of the 
managers, some of whom, at least, should be chosen 
from this body. A question which has given rise to 
some discussion is, " Shall the medical profession be 
represented on this board ?" There can be no doubt 
but that a well trained medical man may be of great 
service to a board of managers, and there is no good 
reason why it should not include one or more physi- 
cians. The physician and layman look at the hospital 
from a different standpoint, and naturally get different 
views, which must be reconciled, and this can be done 
only by intimate association and interchange of 
views, best accomplished, I think, by association on 
the same board. 

The question becomes more difficult to answer if it 
apply to members of the staff. I can see no objection 
to a limited representation. In a hospital which is 
part of a medical school with which I was connected, 
and which has a somewhat complicated organization, 
there are three members of the medical faculty, 
ex officio, on the board of managers, besides three 
members appointed by the alumni of the school, 
while, from the contributors are two more doctors, 
eight out of a board of twenty-four. This is, probably, 
five too many, and their places were better filled by 



HOSPITAL ORGANIZATION 119 

business men of broad ideas and full pocket-books. 1 
In another hospital with which I was also connected, 
one of the richest and best managed in the country, 
there are twelve managers, among whom are no 
physicians, but once in three months the staff is invited 
to dine with the managers, and after dinner the whole 
company adjourns to the board-room, when the 
physicians are asked for suggestions and expressions of 
opinion. At another well known hospital the super- 
intendent, physician-in-chief, surgeon-in-chief, and 
gynecologist-in-chief, and the pathologist constitute 
what is known as the medical board, which meets 
monthly, and whose duty it is to advise the trustees 
in all matters relating to the hospital. These are 
different methods of accomplishing the same object, 
any one of which may suffice. 

The board of managers is commonly divided into 
committees of various importance, as the committee of 
finance, property, the executive committee, etc. The 
only one which needs concern us is the executive com- 
mittee, commonly of great importance. This com- 
mittee represents the managers in all matters needing 
immediate attention. It is the great comforter of the 
superintendent. To its members he goes with his 
doubts, difficulties, and questions of dicipline, which 
they adjust with the authority of the board. The 
executive committee should also make rules governing 
the duties of the officers of this hospital, subject to the 
approval of the board. To be efficient, this committee 
should meet weekly. It is after conference with it that 
the superintendent makes the larger contracts for 
supplies and provisions. In some hospitals there is, in 
addition, a visiting committee, which examines and 

1 Since the above was written a change has been made. The faculty 
managers are reduced to two and the alumni are represented by one 
physician. 



120 SELECTED ADDRESSES 

approves bills, and inspects the wards and other parts 
of the building, but this committee is superfluous where 
there is an efficient and active executive committee. 
It may, however, relieve the executive committee of 
some of its duties. The president and the vice- 
president of the board should be members, ex officio, 
of the executive committee, or invited to attend its 
meetings with a view to securing thorough familiarity 
with all its doings. 

The executive officer of the board of managers is 
the superintendent of the hospital. The superintend- 
ent must be a person of rare qualifications, among 
which are ability, firmness, and tactfulness — qualities 
most difficult to attain, at least, for the salary which 
most hospitals are able or willing to pay. As a con- 
sequence, in one hospital with which I am well 
acquainted, after a very unsatisfactory experience 
with men superintendents, a woman was finally 
engaged. She was sufficiently satisfactory to have 
set the policy, and has been succeeded by several 
others who, with one exception, have held office 
during their will. In every instance the woman has 
been one who has had the training of a nurse. She has 
not herself the charge of the training-school, nor of the 
nurses, any more than a man superintendent, but has 
an assistant to whom these duties are assigned. I 
cannot discover that the administration of this 
hospital at present is in any way inferior to that of 
others of which I know, with men superintendents. 
It must be admitted, however, that this superintendent 
has always had the assistance of an efficient and 
active executive committee. 

A very important officer of a hospital of the present 
day is the chief resident physician, and most hospitals 
of any size have such an officer. He is especially 
serviceable where the superintendent is a woman, as 



HOSPITAL ORGANIZATION 121 

he relieves her of many duties which would be irksome 
or awkward for her. As to his duties : In the absence 
of the visiting chiefs he is the medical authority in the 
hospital, admitting and caring for all patients until 
properly disposed of in the ward to which they 
belong. He is responsible for the proper registration 
of patients admitted. He decides whether the visting 
chiefs or their substitutes shall be sent for. He has 
charge of the sterilizing, operating, x-ray and photo- 
graphing rooms, and is responsible for the sterilization 
and preparation of surgical supplies and dressings, 
and for the condition of all apparatus and instruments 
in use in the hospital, reporting losses and breakage 
to the superintendent. He is the physician of the 
employees, including the nurses, calling the appropriate 
members of the staff in consultation when needed. He 
is accountable to the superintendent and executive 
committee. 

The body on which depend the reputation of the 
hospital and most of its efficiency, is the visiting or 
attending medical and surgical staff. Of late years 
the staff has been very much enlarged in many 
hospitals. Instead of physicians and surgeons, as in 
the old days, there have been added, in many hospitals, 
a gynecologist, and where there is a maternity depart- 
ment, an obstetrician, while the specialties — ophthal- 
mology and otology, diseases of children, skin diseases, 
orthopedics, and genito-urinary diseases — are also repre- 
sented in various ways. 

The mode of their appointment must differ with 
circumstances. I have already said that in a hospital 
associated with a medical school the members of the 
staff must be professors in the school, and certain 
professors must be, ex officio, physicians, surgeons, 
gynecologists, obstetricians, etc., to the hospital. It 
goes without saying that their services must be con- 



122 SELECTED ADDRESSES 

tinuous, subject to such interruptions as vacations 
and sickness necessitate. The best method of rilling 
such interims of service is by assistant medical 
officers in the various services, whose duty is to sub- 
stitute the principals in their absence in addition to 
such other duties as may be assigned to them. These 
assistant physicians, surgeons, etc., should be ap- 
pointed by the managers on the nomination of the 
medical and surgical staff. 

In general hospitals supported by voluntary con- 
tributions, independent of the medical schools, physi- 
cians and surgeons are commonly appointed by the 
managers, who may or may not select men connected 
with the schools. In such hospitals continuous 
service is not usual, the year being divided into terms 
of three, four, or six months. In these hospitals 
assistant physicians or surgeons are not, as a rule, 
appointed, absences and vacations being filled in by 
colleagues, or, in case of this course not supplying the 
deficiency, by appointment, by the managers, of sub- 
stitutes from the dispensary staff or of others. I am 
clearly of the opinion that the best interests of even 
these hospitals would be subserved by a continuous 
term of service, although the advantages of the hospital 
may thus be limited to a smaller number. At the 
same time if an assistant staff be appointed the oppor- 
tunities of the hospital are thus extended, while the 
hospital receives better service from young men 
who have to win their spurs than from overworked 
superiors, who perform their duties in a perfunctory 
manner. 

I am reminded here of a too common practice of 
managers of hospitals of this class which diminishes 
their efficiency. It is the practice of allowing to 
remain on the staff men who do not perform their 
duties, to the exclusion of younger and more active 



HOSPITAL ORGANIZATION 123 

men who would adorn the service. An acknowledg- 
ment of long and faithful service may be made by 
appointment on a consulting or emeritus staff, and 
also by extending the courtesy of the hospital, by 
which is meant the privilege of coming and going at 
will without feeling like an intruder. In hospitals 
connected with medical schools, such practice is less 
likely to occur, as the professor retires from the staff 
when he retires from the faculty. Further, I desire to 
leave a word with physicians and surgeons who omnivo- 
rously take every new hospital position they can get, 
while they continue to hold on to the old ones. This 
is, doubtless, sometimes done thoughtlessly, but a 
lapsed thought is well revived if a competent and de- 
serving man secures thereby a chance. 

In the case of city hospitals where all taxpayers 
have a natural right to representation, while the public 
position of the institution demands, also, that its 
opportunities be shared by students of medicine under 
their own teachers, it is but fair that such division of 
the staff be made that there will be represented in it, 
not only men connected with the schools, but also 
physicians and surgeons not thus connected. But in 
all cases, every member of the staff should be required 
to do some teaching, using the material in his wards 
for that purpose. 

It is most important that a cordial feeling should 
exist between the hospital managers and the staff, for 
upon these two bodies depend the efficiency and repu- 
tation of the hospital. This is accomplished by 
frequent interchange of opinion in one of the ways 
already mentioned. If this is done there is rarely 
misunderstanding if the managers are broad-minded, 
and the members of the staff are considerate. Some- 
times the latter are not. They forget the financial 
responsibility of the managers when the latter hesitate 



124 SELECTED ADDRESSES 

to grant the money for expensive outfits which the 
staff think necessary, with the hospital probably 
running behind a couple of thousand dollars a month. 
I sometimes think the staff is a little extravagant, 
especially the surgical members, as when they insist 
upon a fresh pair of rubber gloves all round every 
time they operate, and throw about costly dressings as 
if they could be had for the asking. On the other 
hand, the staff is responsible for the results of treat- 
ment, and ought to know what it wants and it does 
not do to be too modest. I once heard a manager say 
that he did not like a physician or surgeon who was 
not a " kicker." He was a manager after the heart 
of all physicians and surgeons. 

Next in importance to the visiting medical staff, so 
far as the usefulness of the hospital is concerned, is the 
resident staff. How to secure an efficient resident 
staff is one of the most difficult tasks of hospital 
management. It involves not only the method of 
appointment, but, also, assignment to duty. I fear 
the time will never come when all concerned will agree 
on the method of selection. I have my own convic- 
tions on the subject, but I am sorry to say that many 
differ from me. I am satisfied that the best average 
qualification of resident physicians is obtained by a 
fair competitive examination, which, to be sufficient, 
should be both written and practical. Observe, I do 
not claim that the best individual resident can be 
secured by such an examination, because every one 
who has had experience knows that the young re- 
ceiving the highest mark does not always make the 
best officer. But I mean, given several positions to be 
filled, we are more likely to secure a larger number of 
good men by a competitive examination than through 
the recommendation of interested friends, who, after 
all, know very little about the qualifications of men 



HOSPITAL ORGANIZATION 125 

for whom they ask a vote. Fairness can of course be 
secured by an anonymous examination, properly con- 
ducted. A method in operation in a hospital medical 
school with which I am connected, which has worked 
fairly well, is to send each year to the members of the 
hospital staff the names of the twenty-five men who 
receive the highest averages for the first three years. 
During the fourth year of these students they are more 
or less under the observation of the members of the 
staff, who are thus enabled to become familiar with 
their remaining qualities, and are thus aided in their 
selection. In the hospital referred to, five men are 
chosen annually, and, as I have said, the plan has thus 
far worked fairly well. It would be still better if 
even further opportunity of thoroughly knowing these 
men were given before the final selection is made. As 
it is, the selection may still lie largely in the hands of 
those members of the faculty who are anxious to have 
those appointed in whom they may be interested. 

Even more important from the standpoint of the 
efficiency of service is the assignment to duty of the 
resident physician. The term of service for which 
resident physicians are elected in the majority of 
hospitals, ranges from one year to two years, and in 
general hospitals the more usual method is to rotate 
through the different services, which assigns to the 
resident from three to six months in each service. 
This gives him the opportunity to familiarize himself 
with every variety of special practice furnished by the 
hospital, evidently to his advantage. On the other 
hand, the service suffers from the disadvantage of 
the frequent initiation of an inexperienced resident, 
whose ignorant mistakes are sometimes harmful to 
the patient, and often a sore trial to his chief. There 
seems to be no remedy for this in the majority of 
hospitals. In one of the best conducted hospitals 



126 SELECTED ADDRESSES 

in this country there are three grades of medical 
officers : first, the resident in each service, who is a sala- 
ried officer and is employed for a number of years; 
secondly, under the resident there are three assistant 
residents or internes, who have usually passed through 
the grade of house medical officers, and, having de- 
veloped some special fitness for their work, are ap- 
pointed as assistant resident or internes. These men 
are in the service one or more years, being eligible 
to re-appointment, and some of them eventually 
become residents. Thirdly, under these are yearly 
appointments known as house medical officers, con- 
sisting originally of the twelve honor men of the grad- 
uating class. The house medical officers formerly 
rotated, but the service was unsatisfactory from 
the hospital point of view. For that reason, at pres- 
ent, the house medical officers are permanent, and 
spend their entire year in the service which they enter. 
This must be acknowledged to be the ideal mode of 
service from the standpoint of the best interests of 
the hospital. It is clearly not to the best advantage 
of the resident officers, and in most hospitals it is 
impossible because of its costliness. 

A most important department in a modern hospital 
is the training-school for nurses, which should form a 
part of every hospital, even of moderate size. This 
provides, not only a school for the training of nurses, 
but also efficient nursing for the hospital, as well as 
nursing for private families. The school is generally 
in charge of a superintendent of nurses who directs 
the nursing as well as superintends the instruction 
of nurses, taking part also in the latter. In some 
hospitals the superintendent of nurses is also the as- 
sistant superintendent, replacing the superintendent 
in her absence. In a few small hospitals the woman 
superintendent also superintends the nursing and the 



HOSPITAL ORGANIZATION 127 

training-school, but such a combination overworks 
this officer, and detracts from the dignity of the office. 
It is not to be recommended. 

It is not too much to say that with the above 
objects attained, the training-school is the most 
valuable contribution of modern times to the treat- 
ment of the sick. The management and staff of the 
hospital should, therefore, cordially co-operate to secure 
its highest development and the best results of train- 
ing. These results are only another illustration of 
the good effects of method and training and disci- 
pline. On the other hand, it is with nursing as with 
the profession of medicine, to secure the best results 
it is necessary that the pupil be actuated by some 
higher motive than the mere desire to earn a living, 
and a discipline which rests on hard ruling unaided by 
such motive will fail of its purpose. 

An important department in the administration 
of a hospital is the purveying department. The 
victualing of a large hospital is not less important 
or less difficult than the victualing of a hotel of cor- 
responding size. This is variously accomplished. In 
some hospitals it is in the hands of a single officer 
called the purveyor, whose duties are to purchase and 
deliver provisions, to become familiar with their 
quality, and to keep accurate account of the expendi- 
ture therefor. In other hospitals this duty, so far as 
the contracting for large supplies is concerned, is as- 
sumed by the executive committee in conjunction 
with the superintendent and a woman called the house- 
keeper. These authorities examine the proposals 
and pass upon them, assigning contracts, not neces- 
sarily to the lowest bidder, but to the most satis- 
factory bidder, in determining whom the house- 
keeper is of great service, because she has become 
familiar by experience with the reliability of victuallers, 



128 SELECTED ADDRESSES 

and the quality of provisions furnished by them. In 
one of these hospitals with which I am familiar the 
duties of the housekeeper are, further, to market 
twice a week for certain special supplies, to have di- 
rection of the kitchens, and to see to the proper prepa- 
ration and distribution of food. She is responsible 
for the order and cleanliness of all parts of the hospital 
except the wards and clinic rooms, and has charge also 
of the servants in these departments. There are 
numerous and responsible duties, but in the hospital 
referred to the housekeeper has an assistant. 

This would be a suitable place to consider dietaries, 
but the subject, though important, is too large to be 
considered on this occasion. I will only add that 
dietaries, as a rule, are too liberal and extravagant, 
and much money is wasted upon them. Thus, until 
recently revised, the dietary in one of the hospitals of 
Philadelphia included in the full diet of a ward 
patient, meat three times a day. Such wilful waste 
must lead to woful want. 

The dispensary, or out-patient, department of a 
hospital has become a trying problem, more especially 
in view of the fact that it is often availed of by persons 
who should pay a physician for his services. In the 
general hospital, which has not teaching for one of its 
primary objects, the dispensary was first instituted 
to relieve the pressure on the wards. When I was a 
young physician in Philadelphia I do not think there 
was a single hospital which had a dispensary depart- 
ment, and at the Pennsylvania Hospital where I was a 
resident physician in 1863-4 we received even fractures 
of the upper extremities in the wards. In the course 
of time it became evident that there was no reason 
why these cases should not sleep at home and return 
to be dressed as often as necessary, giving place to sick 
and wounded who must be treated in the wards. So 



HOSPITAL ORGANIZATION 129 

the dispensary was started, and grew. One of the 
out-patient surgeons of this hospital informed me that 
on one day recently, 200 cases were treated in 
that service only. 

In teaching hospitals the dispensary serves another 
important purpose, viz., a supply of material for 
teaching students. In my student days the dis- 
pensary was the only source of teaching material con- 
nected with the school. To-day in the best schools it 
is supplemented by the hospital. Notwithstanding 
this, the large medical school is still crying for more 
clinical material. Hence it cannot afford to dis- 
criminate against any applicant for treatment. -Even 
the general hospital independent of such demand, finds 
great difficulty in discriminating against those able to 
pay. This, indeed, is the problem agitating the 
trustees of general hospitals at the present day through- 
out the country. 

The dispensary department connected with medical 
schools becomes a very complicated and expensive 
system. Thus at the hospital of the University of 
Pennsylvania there is a separate dispensary, with dis- 
pensary staff for general medicine, general surgery, 
diseases of children, gynecology, obstetrics, ophthal- 
mology, otology, laryngology, dermatology, genito- 
urinary diseases and orthopedic surgery, the head 
of each dispensary being the head of that department 
in the hospital, with assistants. Such a multiplicity 
of services can only be successful through a central 
bureau with a clerk, who makes certain preliminary 
records, such as the names, sex, occupation, etc., of 
the patient, and with a physician who shall classify 
and assign the patients to their respective depart- 
ments. Where a clerk is in charge, he may be as- 
signed the duty of determining the ability of a patient 
to pay for services rendered him, and for medicine 



130 SELECTED ADDRESSES 

prescribed for him. It has become quite a general 
practice of late for hospitals to charge cost price or a 
small fixed sum for medicines furnished to dispensary 
patients, except in special cases. 

The rooms for private patients are an important 
feature in the modern hospital, adding much to its 
usefulness and efficiency, but also to the difficulties of 
its administration. No hospital should be built 
without them. The objects of the private rooms are 
two : First, they should be a source of revenue to the 
hospital, to be applied to the expense of supporting 
free patients ; second, they should provide a haven for 
the well-to-do patient who has not the convenience of 
a home, or, having a home, cannot be treated as safely 
or as successfully in it. Withal, the hospital idea in the 
strict application of the term should be borne in mind. 
The patient is a guest whose suffering is to be eased, 
and his wants ministered to, for a sufficient and 
reasonable sum, and the aim should be to make the 
cost of the private rooms as moderate as shall secure a 
fair and moderate profit. As there are always, how- 
ever, certain very rich persons who demand appoint- 
ments more luxurious than is really necessary, there 
may be provided a number of private rooms or suites 
with bath for which a coiTesponding charge should be 
made. 

As to the prices which ought to be charged, a few 
single rooms should be available at $15 a week. This 
seems to be a minimum fee in the large cities, as the 
average cost of maintenance per day in a well appointed 
city hospital is seldom less than S2 a day, averaging 
the free and private patients together. From this 
sum upwards, prices should rise to $50 and even $100 
or more a week according to the size, furnishing, and 
conveniences of the rooms. In small county towns 
where expenses are less, single rooms may be supplied 



HOSPITAL ORGANIZATION 131 

at $10 a week. Some hospitals make an additional 
charge of $10 for the operating-room in private cases 
which come to operation. This I do not consider 
justified. A charge for dressings where their cost ex- 
ceeds a certain sum is, in my opinion, more allowable. 
The charge for a private room includes commonly 
the services of the resident physician, dressings, 
medicines, and whiskey when ordered as medicine, 
but not wines or mineral waters. It includes also 
ordinary nursing, that is, the services of a nurse who has 
charge of the nursing in four or five rooms. Where a 
special nurse is desired, as is very apt to be the case, 
an additional charge of $20 a week is made for this 
nurse, and $8 for her board, so that the expenses of the 
private patient rise rapidly. However, they are still 
in most hospitals a good deal less than corresponding 
accommodations at a first-class hotel. It is to be 
remembered that I am speaking of general hospitals, 
whether associated or not with medical schools. 
Private and special hospitals are necessarily more ex- 
pensive because of the smaller number of patients, 
and relative increased cost per capita. The charges in 
some of these is, however, excessive. 

It will be noted that the charge for private room 
does not include the fees of the physician or surgeon, 
since the patient avails himself of the hospital in- 
stead of a hotel. The physician or surgeon should, 
however, remember that the hospital affords him 
many facilities in the treatment of his private patients, 
and he should be willing to remit his fees in the case 
of respectable people in moderate circumstances who 
cannot afford the expense of a private room and a 
physician or surgeon as well. 

A maternity department rounds up the usefulness 
of a hospital in several ways. In the first place, it 
affords a haven of rest with efficient and gentle treat- 



132 SELECTED ADDRESSES 

ment to a class of patients who deserve our sympathy 
beyond all others. In the second place, it enables 
the nurse to perfect herself in a line of nursing which 
is more indispensable than any other. Last, but not 
least, it affords a school for medical students in which 
they can be taught practical obstetrics under safe and 
efficient guidance before graduating, thus protecting 
their future patients from accidents which could 
otherwise be scarcely avoided because of inexperience 
and lack of practical training. It is a popular de- 
partment, and can usually be supported more easily 
than any other because of the sympathy its objects 
excite, and the comparative ease with which money 
can be collected for its support. It is especially use- 
ful in a hospital connected with a medical school 
when, of course, the professor of obstetrics will be 
at its head. The influence of the lying-in depart- 
ment is towards morality and against crime. The 
temptation to infanticide is diminished, and when in 
charge of a committee of sensible and high-minded 
women the future lives of wayward girls may be 
favorably influenced. Where conditions favor its 
maintenance a maternity department should form a 
department of every general hospital. 

Hospital finances are too large a subject to be dis- 
cussed at length on an occasion like this, and I will 
pass them over with an allusion. With hospitals, as 
with all else, money is necessary, and the amount re- 
quired increases steadily with the development of new 
methods of medical and surgical treatment and the 
inevitable gradual increase in the expense of living. 
"Pay as you go" is an adage as applicable to hospital 
as it is to other expenses. I fear very few hospitals 
live up to this sound rule. I know of but one or two. 
On the other hand, certain managers take the ground 
that it is good policy to be behind and in debt, as it 



HOSPITAL ORGANIZATION 133 

attracts attention, and stimulates effort. I know at 
least one hospital in Philadelphia that is to-day 
running behind at the rate of $2,000, and more a 
month. To go into debt for building is worse; yet I 
have known several hospitals on which there is now 
no debt to have been built by stages, with debt 
contracted for each succeeding stage. 

It is hard to advise how to raise money to build 
and support a hospital. In answer to a question 
"How shall it be done?" I should answer, in every 
possible way — by begging, by entertainments, by 
board of patients when they can pay. Many patients 
can pay a little who cannot pay much, especially 
where operations are done, which, if done in private, 
would cost hundreds of dollars. By calling attention to 
such facts as these the patient may be able alone, or 
with the assistance of friends, to raise a small sum 
towards his board. Much time and work is sometimes 
wasted on entertainments, the expense of getting them 
up consuming nearly all, and sometimes more than is 
derived from them. Yet I have known handsome re- 
turns to be derived from entertainments. Much de- 
pends on what they are, and how they are managed. 
The same amount of energy spent in asking contribu- 
tions from individuals will often be more fruitful. 

When a hospital attains a certain age, having been 
well conducted and kept before the public, it secures 
its own contributions. Testators in looking for worthy 
charities to which to bequeath their money, select 
those best known and best managed, and those with 
whose object they have most sympathy. 

Too often the burden of collection falls on a few. 
I sometimes doubt whether any person has a right to 
be a hospital manager unless he is able to give or col- 
lect some money annually; but I fear if we made this 
condition our board of managers would be very small. 



134 SELECTED ADDRESSES 

But, every hospital manager should be a contributor 
of at least $50. 

There are many more details in the management of 
hospitals which might be included under hospital 
organization, such as the employment and duties of 
subordinate officers employed by the superintendent, 
including engineers, clerks, cooks, orderlies, and the 
like, which are scarcely appropriate to an occasion 
like this. Many are self-evident while others vary so 
much with different executive methods that it would 
be unprofitable to dwell upon them. 



VIII 
THE TRAINED NURSE 



VIII 
THE TRAINED NURSE 1 

The training school commencement is a latter day 
event of such importance that it has found its place in 
the calendar of every hospital sufficiently large to afford 
the experience necessary to a proper training of nurses. 
Next to the physician himself, and at times even 
before him, there is no one on whom the fate of a sick 
man or woman so much depends as on the nurse. 
Assuming, therefore, that the commencement which 
announces that the young women who graduate are 
qualified, by this crowning event in their training, to 
take up the great responsibility of nursing, there is 
every reason why it should be publicly proclaimed for 
the benefit alike of the community and the graduates. 
By the public commencement, these two are, as it 
were, introduced to each other for the first time and 
the opportunity of establishing further relation is 
opened. 

I have had much experience with nurses, as pupils in 
the training school and hospital wards, as nurses in 
charge of wards and in private practice. I was for 
many years on the training-school committee of two 
of the largest hospitals in Philadelphia, and probably 
have examined for graduation more candidates and 
signed more diplomas than any other physician in 
that city, while in my long experience I have formed 
many friendships among them. I feel, therefore, that 
I may speak freely to you and for you without fear of 
being misunderstood. My sole object in any sugges- 
tion or criticism I may make is to help you, and I may 

1 Ad Address Delivered at the Graduation Exercises of the Training 
School for Nurses of the Pennsylvania Hospital, March 13, 1907. 
Reprinted from The Dietetic and Hygienic Gazette, July, 1907. 

137 



138 SELECTED ADDRESSES 

add that the thoughts and conclusions I shall present 
have been suggested by actual events in my own ex- 
perience, and are therefore practical and not theoretical, 
though they may seem commonplace. 

You have had the advantage of working more or less 
according to rule and after a system. You have had 
prescribed duties. These you have performed more or 
less efficiently according as you have been individually 
apt, conscientious and anxious to please. However 
much you may differ from one another you have 
satisfied those who have been the judges of your 
merits. By reason of this you have been permitted to 
enter upon a new field, a field in which you will not 
have the advantage of defined and regulated duties. 
You must think for yourselves and act for yourselves. 
Unexpected situations unlike those you have encount- 
ered even in a large hospital experience will arise 
before you and demand prompt and original treatment. 
Your patient may not be so different from your 
hospital cases, but it is not the patient alone you will 
have to treat. The mother, the wife, the sisters — I 
will except only the brothers — but all others, not ex- 
cepting servants, must be handled with a tact and di- 
plomacy which rarely comes to anyone without training 
and with self-control developed by experience. 

Such self-control and tact will come to some easier 
than to others, but in all it will be aided or retarded 
by the motive and spirit which has led you to choose 
your calling, which, while it may not be a profession, is 
something above a trade or mere occupation. I fear 
most of you do not differ from the average mortal, 
in whom necessity plays a more or less important role 
in the determination of an occupation, but fortunate 
is she who is actuated in part also by a higher motive, 
and most fortunate she whose chief stimulus is a 
desire to be useful in life and to contribute her jnite 



THE TRAINED NURSE 139 

towards the general weal of the human family. You 
will need a motive like this to sustain you in situations 
such as I have named. But long before this in your 
ward work you will have learned that the life of a nurse 
is no sinecure, and if you have formed any romantic 
notions about it they will long since have been dispelled. 
Most probationers are called to settle these questions 
at the outset of their career — the very first week, often 
the first day in the wards of a hospital sufficing to 
dissipate all romance. When vermin, and filth, and 
disease germs enter at the front door, romance vanishes 
by the rear. 

A burning queston, one of the earliest which you will 
meet, at the very threshold of your career, is that of 
compensation for services, and the difficulties en- 
countered are similar to those which beset the physi- 
cian under like circumstances. From one point of 
view it may be true that the services of the physician 
cannot be measured in money. They are beyond 
price. On the other hand, if the poor unfortunate to 
whom these priceless services are rendered has not a 
dollar with which to pay for them, it matters not how 
valuable they are, the doctor must go unpaid. If the 
patient has moderate means the pay may be propor- 
tional. If he be rich, then may the physician expect to 
receive some adequate compensation for his services. 
So it is with the nurse. Her services are at times, in- 
deed without price, but she cannot avoid setting a 
value upon them. Now, I hold that a nurse's charge, 
like a physician's, must be based on her experience and 
adapted to the circumstances of her patient. The 
family of moderate means, which, in addition to the 
burden of sickness and doctor's fees and medicines, has 
to add that of a trained nurse, is often sorely tried to 
make ends meet. No nurse at her graduation is worth 
$25 a week, yet I have known many to ask it for their 



140 SELECTED ADDRESSES 

very first case. I have also known a nurse to insist 
upon the maximum fee when the physician in attend- 
ance has been indifferent as to his own fees and has 
asked for some consideration in behalf of the family. 
There came to my notice lately the case of a young 
married woman who was making preparations for her 
first confinemenet. She had obtained her baby's 
outfit and had expended what seemed to her a great 
deal of money. She thought she could not afford to pay 
$25 a week for a nurse. She tried in vain to get one 
for less and finally, in a fit of despair, cried out, "no 
wonder people don't want to have children." I knew 
of another nurse registered at the College of Physicians 
who declined to take a case because her personal 
comfort was not assured. Such nurses are standing 
in their own light. From the point of view of self- 
interest the young nurse who insists on the same 
weekly stipend as her more experienced sister is 
making a mistake. The physician does not forget the 
one who came to his rescue in a trying case, regardless 
alike of pay and discomfort. Especially in your early 
experience, therefore, be not too exacting of fees, but 
accept as part return, at least, the satisfaction which 
comes of doing good for its own sake. Cast some bread 
upon the waters, and it will surely return to you, 
though it be after many days. As your experience 
grows and you find your services appreciated you may 
then ask for those higher fees which, when obtained 
and permanently secured, make the calling of the 
nurse one of the most profitable in which a woman 
can engage. 

Another question which has to be settled early, and 
which often excites more discussion than it deserves, 
is the place of the nurse in the family. Shall she, for 
example, take her meals at the table with the family? 
The views of families differ in this respect and it is the 



THE TRAINED NURSE 141 

nurse's duty to fall in with their ideas. In point of fact 
it is usually more satisfactory for the nurse to take her 
meals alone after the family has finished, if the patient 
is not so ill as to make it unsafe for her to, go far from 
the sickroom. On the other hand, I should deem that 
family guilty of gross discourtesy as well as ingratitude 
if they failed to invite to join them at a meal a faithful 
nurse who happened to be calling at the meal hour. 
Far more frequently in my experience does such nurse 
become a friend always warmly welcomed at the hearth- 
stone and table of the family she has served in the 
distress of a severe illness. 

While on the subject of table and food, it is exceed- 
ingly important that the nurse should appreciate the 
significance of delicacy in the method of serving a 
meal to a patient. Not all persons are equally exact- 
ing, but there is "probably no one who objects to 
daintiness in this particular. The fresh napkin, the 
polished glass and the bright silver, neatly arranged 
on a tray, stimulate the appetite in a surprising way, 
while the opposite appointments often disgust a sen- 
sitive patient. It may be a matter of surprise to 
some, but an over-abundance of food, a surcharging 
of plates with this and that, detracts from that dainti- 
ness of service which goes far towards the preparation 
of an appetizing meal. A higher degree of indif- 
ference sometimes leads the nurse to serve drink in 
an unwashed tumbler or medicine in a spoon un- 
washed since its last service. I have known a little 
child to resent such services in a nurse who was 
otherwise excellent. 

A habit of spotless cleanliness is an attribute which 
is most indispensable in a nurse, both in person and 
dress. " Cleanliness to fanaticism " is a favorite 
expression of a most successful chief nurse and train- 
ing-school superintendent whose methods I admire, 



142 SELECTED ADDRESSES 

which conveys in a nutshell all that need be said to 
emphasize the importance of this matter. To carry- 
out this dictum it is necessary that a nurse should 
have a certain amount of time daily to herself, not 
only for rest, but also to freshen her dress and ap- 
pearance, which will make her more attractive and 
no less efficient to her patient. Families, more 
often from an oversight or abstraction growing out 
of anxiety rather than inattention, overlook these 
needs of the nurse, and it is the family physician's 
duty to look after this. Whenever possible the 
daily tub-bath should be had, not only for this purpose, 
but also to keep up the health and good spirits of the 
nurse, so essential in the house of sickness. For the 
latter purpose also is essential the daily walk in the 
open air. On the other hand, it does not do to be too 
exacting in these matters, since circumstances arise 
where on account of desperate illness they must be 
ignored for a time, however desirable they may be. 
I have known nurses to be needlessly disagreeable 
in insisting upon these prerogatives and to forfeit 
the esteem of family and physician by such a course 
of conduct. I once had a nurse who had many ex- 
cellent qualities who became offended because she 
was not formally introduced to the physician to whom 
I was to transfer the case and would not come into 
the room when he made his next visit, making it 
necessary for him to go out and hunt her up. It 
was an oversight on my part and I apologized to 
the young woman, but seemingly she was not ap- 
peased. It is needless to say that a few days later I 
was asked to obtain another nurse for this patient. 

On the other hand, it does not follow that the 
nurse is always to blame when it becomes necessary 
to make a change, and it is not reasonable to expect 
that a given nurse, however excellent, is adapted to 



THE TRAINED NURSE 143 

every patient, so that it sometimes becomes neces- 
sary for us to make changes for no fault of hers. Some 
nurses are admirable for men who are not at all suit- 
able for women. Some of you may have read an in- 
teresting story by Frank Norris entitled "A Man's 
Woman/' in which the heroine was a trained nurse 
with many noble qualities, but evidently better 
adapted to nursing men than women, albeit, she was 
found wanting in a situation of a man's making, when 
she gave up nursing one man who lay low in the 
Valley of the Shadow of Death because another man, 
whom she loved, commanded it. I know a nurse 
than whom I want none better to nurse a man, but 
who was quite unsatisfactory in nursing a delicately 
organized woman. Not only this, but we find some 
nurses altogether unsuited to certain patients where 
it is almost impossible to give a reason. In such cases 
you must be content to take the doctor's advice, and 
withdraw in favor of some one else who may or may 
not be better suited than yourself for the case. 

And this brings me to the relations of the physi- 
cian to the nurse — relations which are of acknowledged 
importance. There should be the clearest under- 
standing between these two associates naturally 
leagued against disease and its consequences. The 
nurse is the lieutenant of the doctor, upon whom de- 
pends largely the success of the treatment laid down 
by him. But this is not her only office. There are 
many matters which devolve on her for which her 
knowledge and training befit her which she must 
carry out without directions from the physician. 
It is not easy to enumerate these. The most im- 
portant is, perhaps, close observation of events in 
the course of the case which may be of value to the 
doctor in the rearrangement of the treatment. Hence, 
one of the most important duties of the nurse is her 



144 SELECTED ADDRESSES 

report to the physician of what has transpired in his 
absence. Herein is room for the most consummate 
skill. The reports of some nurses are as much too 
full as those of others are too meagre. Experience, 
tempered by judgment, can alone teach her the golden 
mean so much desired. The nurse should be most 
circumspect in her conversation with the patient's 
family concerning the doctor. She is rightly or 
wrongly regarded as knowing all about mm. It is 
scarcely necessary to say to you that she should be 
loyal to him and avoid unfavorable comment on his 
conduct or treatment. On the other hand, fulsome 
praise is, to say the least, in bad taste, and the sen- 
sible doctor does not care for it. While the nurse 
should not be too ready with suggestions or informa- 
tion, the alert physician will want to know her views 
and often profits by them. She is but a poor nurse 
whose constant intercourse with her patient does not 
lead to the discovery of data unnoticeable at the brief 
visits of the doctor, which may be of service to him. 
I have had much valuable help from nurses in this way. 
Yet there are physicians who resent such informa- 
tion, and you must learn by experience the temper 
of each physician. 

The nurse's duty to the patient implies a respon- 
sibility no less important than that to the doctor. 
All that has been said as to the latter holds also of 
the former. But more than this is implied. Among 
the additional obligations that of trust stands out 
conspicuously. Necessarily at times the nurse ac- 
quires a knowledge of the shadows which befall the 
families and person of her patient and the skeletons 
their closets conceal. Instead of approaching them 
with curious gaze she should regard them with 
averted head and veiled eye. Still more must they 
be held as secrets to be disclosed to no one, rather 



THE TRAINED NURSE 145 

indeed, to be forgotten as soon as possible. In minor 

matters, too, the nurse should be watchful and not 

allow herself to unwind the spool of gossip, to which 

there is always, naturally, temptation, especially in 

the weary hours of convalescence, which sometimes 

hang heavily on patient and nurse alike. And in this 

connection, I may add, I hope you have had some 

training in reading aloud, which becomes so often a 

pleasant occupation for such seasons. Far be it from 

me, however, to revive the old idea of nursing, that 

it consists in a book, a fan and a glass of water. 

A word in conclusion as to the compensations of 

your calling, apart from those of pecuniary reward. 

You will need the thought of them at times for your 

encouragement in the darker hours when everything 

seems to go wrong in spite of your best endeavors. 

It appears to me there can be nothing more sustaining 

than the thought that one is striving to save a human 

life. The very idea of life, with the mystery of its 

coming and its going is awe-inspiring, and none who 

have watched it through the flickering of its waning 

until the last spark has gone, as physicians and 

nurses often do, can fail to realize this awe. The 

responsibility of taking life has always been regarded 

as most serious and, when wilful, to be atoned for 

only by the life of the destroyer. The saving of a 

life, too, in the ordinary experience of the world, is 

regarded as an act worthy of the highest praise, and 

medals and decorations are daily awarded to life-saving 

heroes. Yet how little thought is commonly given 

to the same act as accomplished by the nurse, a silent, 

lonely sentinel on the watch, often exposed to as 

much and more danger than is the brave mariner, 

soldier or fireman. I do not think you need wish 

that there should be greater publicity to these acts 

than there is. On the other hand, a career spent in 
10 



146 SELECTED ADDRESSES 

the constant effort to attain such noble ends must be 
elevating and purifying, carrying with it in large 
degree its own reward. I am one of those who have 
always favored ' opening to woman any occupation 
which commends itself to her tastes and abilities, 
but it has seemed to me there is no calling to which 
the higher qualities of her nature so well adapt her as 
that of nursing. Owen Meredith has said this so beauti- 
fully in his most charming of English poems, Lucile, 
— you should all be familiar with it — that I feel I 
cannot more appropriately conclude what I am saying 
than by quoting the lines which embody the thought : 

"The mission of woman: permitted to bruise 
The head of the serpent, and sweetly infuse, 
Through the sorrow and sin of earth's register' d curse, 
The blessing which mitigates all: born to nurse, 
And to soothe, and to solace, to help and to heal 
The sick world that leans on her. This was Lucile." 



IX 

MEMOIR 

OF 

ALBERT HOLMES SMITH, M.D. 



IX 

MEMOIR OF 
ALBERT HOLMES SMITH, M.D. 1 

There are few of our older Fellows who do not 
know that Albert H. Smith lived for a purpose, 
and that his life successfully portrayed would be a 
wholesome example. To paint a portrait such as my 
fried deserves, and such as will, at the same time, serve 
the purpose alluded to, requires, I know, a skill rarer 
than my own. But, regarding my nomination by 
the College to the duty as a compliment I can best 
acknowledge by attempting its fulfilment, I shall do 
so, with, I trust, a due appreciation of its difficulties. 

The parents of Dr. Smith were Moses B. Smith, 
M.D., and Rachel Coate Smith. Dr. Smith's father 
was a man whose life has furnished one of the most 
interesting medical biographies it has ever been 
my privilege to read, and in its perusal one is so con- 
stantly reminded of the life of the son, that on this 
account I feel justified in reviewing some of its more 
interesting portions. 

Descended from Quaker ancestors who were among 
the earlier settlers of Pennsylvania, and who had 
emigrated from Yorkshire, England, about the year 
1685, Moses B. Smith was born in Solebury, Bucks 
Co., September 29, 1787. He studied medicine at the 
University of Pennsylvania, under Rush, Physick, 
Dorsey, Wistar, Barton, and James, graduating in 
March, 1814. He immediately began the practice 
of medicine in Bustleton, Philadelphia County, and 
soon acquired a very large practice, visiting and pre- 

1 Transactions of the College of Physicians of Philadelphia, February 
2, 1887. 

149 



150 SELECTED ADDRESSES 

scribing at times for upward of eighty patients a day, 
and being seldom able to see the same patient every 
day, unless very ill indeed. After fourteen years of 
laborious but lucrative business, he moved, in 1828, 
to Philadelphia, for the purpose of educating his 
children. But it was not long before he was again 
deeply in practice, so that by November, 1832, he 
was so broken in health that he was compelled to 
relinquish it, never to resume it. 

Very interesting to medical men, at least, is the 
fact that he noted at this time the commencement 
of a tumor in the abdominal cavity, to the right of the 
umbilicus and embracing portions of the right iliac 
and right hypochondriac regions. By means of active 
treatment, including, in his own language, " repeated 
bleeding, cupping, antimoniatizing, iodizing, and three 
months salivation, with all the auxiliaries that could 
be devised/' the tumor was said to have been " finally 
subdued, and he seldom experienced much inconven- 
ience from it, although it could be distinctly felt ever 
after, below the margin of the ribs." 1 

He lived, though with impaired health, twenty- 
three years longer, dying on the 15th of July, 1855, 
from the effects of valvular disease of the heart, of 
which the diagnosis was made some time before death, 
and established in an autopsy by Dr. James E. 
Rhoads, now the accomplished President of Bryn 
Mawr College. The only conditions which might 
explain the tumor which had given him so much 
trouble, were a misplaced right kidney and an enlarged 
right lobe of the liver. The former lay in an oblique 
position, from above downward, and from left to 
right across the bodies of the vertebrae. The latter 
projected a little below the margin of the ribs, and 

1 Biography of Dr. Moses B. Smith, in the Transactions of the 
Medical Society of the State of Pennsylvania, 1856-60, p. 189. 



ALBERT H. SMITH, M.D. 151 

may have been the remnant of a greater enlargement 
during the time of the supposed existence of the 
tumor. The kidney contained a small calculus em- 
bedded in its substance, but was otherwise normal. 

Albert H. Smith was the third son, and youngest 
of seven children, of Dr. Moses B. Smith, and was 
born on the 19th of July, 1835, at the northeast corner 
of Sixth and Vine Streets, Philadelphia. Of Dr. 
Smith's boyhood I have been able to learn little, 
except that he was slender in build, but not delicate. 
We hear of him as a boy at Westtown Boarding School, 
and again as a student in Gregory's well-known classical 
school in Philadelphia. 

At the age of thirteen he was fully prepared to enter 
the Freshman Class in the University of Pennsylvania, 
and passed the examination for admission, but was 
kept back a year on account of his youth. He entered 
in 1849, and received his bachelor's degree in 1853, 
with the third honor of his class. In the autumn of 
the same year he entered the Medical Department of 
the University, and was graduated M.D. in 1856. 
He was an office student of the late Professor George 
B. Wood. 

Very soon after graduating, Dr. Smith was appointed 
Assistant Physician to the Friends' Asylum for the 
Relief of Persons deprived of their Reason, at Frank- 
ford, near Philadelphia, then under the charge of the 
late Dr. Joshua H. Worthington. A short time only 
after taking this position he was placed in sole charge 
during Dr. Worthington's absence in Europe. His 
administration was, in all respects, satisfactory to the 
managers, and was one of the events which prepared 
the way for his subsequent large practice. Dr. 
Smith always recalled with pleasure his long residence 
in this institution, and I well remember a visit paid 
with him to the spot on a lovely afternoon in July, 



152 SELECTED ADDRESSES 

1881, when, exultant in health and strength, he had 
the prospect of a long and useful career before him 

From the Frankford Asylum, he passed, in 1857, 
to the Pennsylvania Hospital, where he spent the 
then usual term of eighteen months as resident phy- 
sician. Here, as elsewhere, the same fidelity and 
thoroughness characterized his work, and I have more 
than once heard one of the most exacting surgeons 
whom he served, say of Smith, that he was among 
the best residents the hospital ever knew. The phy- 
sicians of that day were Wood, Pepper, Gerhard, 
and Levick; the surgeons Xorris, Peace, Xeill, and 
Pancoast. Xo ex-resident whom I ever knew quoted 
more frequently the sayings and practices of his mas- 
ters than did Dr. Smith, and he seemed to have ab- 
sorbed that which was best from each. Perhaps no 
hospital in the world is held more dear by its ex-resident 
physicians than the Pennsylvania. Xo hospital is more 
fondly revisited, and no fraternit}^ is characterized by 
closer bonds than those which unite the band of its 
ex-residents. Of these, Albert Smith was one of the 
most loyal. Xo occasion which called for a gathering 
of the old residents, or demanded the opening of the 
purse for any purpose intended to revive old memories, 
was ever intentionally overlooked by him, and no 
pressure of business kept him away from the reunions 
which, from time to time, took place. 

Leaving the Pennsylvania Hospital in 1859 he 
immediately began practice, and it was not long before 
he became busy. Having selected obstetrics as his 
specialty he was promptly elected, in the same year, 
Assistant Physician to the Philadelphia Lying-in 
Charity. In 1860 he married Emily, daughter of 
Charles Kaighn, Esq., of Kaighn's Point, Xew Jersey. 
In 1862 he was chosen one of the visiting obstetricians 
to the Philadelphia Hospital, and the next year 



ALBERT H. SMITH, M.D. 153 

attending physician and lecturer to the Philadelphia 
Lying-in Charity. Upon the duties of these positions 
he entered with great enthusiasm, but it was the 
Lying-in Charity to which he devoted his chief 
energies, building it up, developing and enlarging its 
sphere of usefulness. He did not continue long an 
attending obstetrician to the Philadelphia Hospital, 
but he never lost interest in the Lying-in Charity, 
which was always the most valued of his public posi- 
tions. While myself an assistant in this charity I 
had the largest opportunity of estimating his interest. 
Whether it was in the mere writing, in his handsome, 
distinct chirography, of a note of assignment of a case, 
to a pupil or assistant, or aiding in a difficult obstetric 
operation at any time of day or night, it was always 
with the same cheerful and untiring interest. 

In his courses of lectures at the Lying-in Charity, 
Dr. Smith cannot be said to have been eloquent, but 
his thorough knowledge of the subject, his earnestness, 
and the practical character of his teaching, attracted 
very large classes, and no teacher connected with the 
institution had larger ones. He continued his associa- 
tion with this charity as long as he was able to attend 
to business, preferring to neglect lucrative private 
work for the duties of his position. 

As he grew older, other positions sought him, and 
he was, at various times, physician to the House of 
Refuge, consulting physician to the Woman's Hospital, 
consulting accoucheur to the Preston Retreat, and 
consulting physician to the House of the Good Shep- 
herd. He was one of the founders of the Philadelphia 
Obstetrical Society, and its president in 1874-76; 
also one of the founders of the American Gynecological 
Society, and its president in 1884. The preparation 
of his address for the meeting at Chicago was his 
last literary effort. It was prepared at his cottage at 



154 SELECTED ADDRESSES 

Beach Haven, N. J., during the summer preceding 
the autumn in which it was read, amid illness and 
suffering which would have deterred most men from 
undertaking it. Dealing chiefly with the celebrated 
discussion before the Academy of Medicine of New 
York, on the nature of puerperal fever, between Drs. 
Fordyce Barker and Gaillard Thomas, it is replete 
with evidence of research, and inbued with the spirit 
of fairness and love of truth characteristic of its author. 
He also attacks in this address the tendency which, 
he says, is " observable mainly and almost entirely 
in the productions of gynecological writers and 
teachers" to publish articles made up of facts real and 
fancied, which are in no way a contribution to science, 
while they minister to a depraved and prurient taste 
which should be least fostered by a profession like 
that of medicine. 

In the early part of the last year of his illness Dr. 
Smith was chosen an Honorary Member of the British 
Gynecological Society, an honor which he valued above 
all others conferred upon him. 

Besides being a Fellow of this College, Dr. Smith 
was a member of the Philosophical Society, of the 
Pathological Society, a manager of Wills Ophthalmic 
Hospital from 1863 to 1871, a delegate to the Inter- 
national Medical Congress held at Philadelphia in 
1876, and a deeply interested member of the Phila- 
delphia County Medical Society. He was president 
of the latter in 1880 and 1881, and during his term of 
office inaugurated a series of receptions to its members, 
which were always crowded, and did much to increase 
the interest of members and the prosperity of the 
Society. 

It is in connection with his membership in the 
County Medical Society that Dr. Smith's position 
in relation to the movement for the admission of 



ALBERT H. SMITH, M.D. 155 

women physicians to that Society should be considered. 
To pass over the part played by him in this movement 
would be to ignore a chapter in his life in which are 
reflected some of the most marked and distinctive 
traits of his character. It was, perhaps, in conse- 
quence of the associations growing out of his being a 
member of the Society of Friends that he was inclined 
to look without disapprobation upon women seeking 
the field of medicine for occupation. He became 
consulting physician to the Woman's Hospital in 
1867, at a time when the acceptance of such position 
implied a moral courage which few possessed. Soon 
thereafter a resolution was offered before this College 
making it an offence punishable with expulsion to 
consult with women physicians. This was, of course, 
aimed against Dr. Smith and others who had accepted 
positions as consultants on the staff of the Woman's 
Hospital. At a large meeting of the College, after a 
protracted and heated debate, the resolution was lost. 
He continued an ardent supporter of the cause in- 
volved, regarding no sacrifice required for its further- 
ance too great. When the State Medical Society 
met at Lancaster in 1882, a resolution was brought 
forward recommending the appointment of women 
physicians in the female departments of the State 
institutions for the insane. Dr. Smith at that time, 
although weighed down with professional care, went 
to Lancaster each day that he might be present at 
the discussion of the resolution, and returned to 
Philadelphia in the evening to attend to his practice. 
In the various attempts which have been made on 
the one hand to elect women to the Philadelphia 
County Medical Society, and on the other to make 
them permanently ineligible, Dr. Smith was always 
present, speaking to the cause in his most earnest 
manner, and yet never offensive or discourteous to his 



156 SELECTED ADDRESSES 

opponents, whatever may have been their manner 
toward him. No one ever questioned his motives, 
and though he may have lost some of the extreme 
popularity which he held, yet no other member, 
in view of the large opposition, would have lost as 
little, so satisfied were all of the purity and unselfish- 
ness of his motives. Though he suffered keenly the 
loss of friends, for his attachments were strong, he 
would not have swerved from his purpose had all 
deserted him. Yet he was no more unreasonable 
than he was unselfish, and he would earnestly seek 
counsel of those whose judgment he valued, although 
they might not share his opinions. Although he did 
not succeed in accomplishing his cherished purpose 
of his life, in securing for women membership in the 
County Society, he has probably, in the willingness 
with which he lent his services to them at what I 
know was great personal sacrifice, done more than any 
medical man to secure acknowledgment for the posi- 
tion of medical women, and to elevate the standard 
of their education. 

From almost the beginning of his private practice, 
Dr. Smith's business, both general and special, grew 
rapidly. His interest in his cases was so great, and 
his devotion so thorough, that they were irresistible, 
and he soon had a very large practice, not only as an 
obstetrician, but also as a general practitioner, and of 
later years as an operating gynecologist. His powers 
of physical endurance for a number of years exceeded 
that of any one I ever knew. He would lose sleep 
night after night, and would work throughout the 
day without the least evidence of fatigue. He 
preferred to have his obstetric work at night, that his 
day might be uninterrupted. It seemed for a time as 
though he could not break down. Yet the time at 
last came, in February, 1880, when, after determined 



ALBERT H. SMITH, M.D. 157 

opposition on his part, he went to bed with an illness 
which proved to be typhoid fever. From this illness 
he recovered, and sailed in June for Europe, returning 
in the autumn, apparently in perfect health. While 
abroad he established many warm friendships, more 
particularly among those working in his own specialty; 
and after his return his hospitable home was frequently 
availed of by English and Scottish visitors. 

Immediately on his return he plunged into work, 
and in a few days was as busy as ever. In the autumn 
of 1882 the symptoms of his final illness presented 
themselves, and for a long time, doubtless, he con- 
cealed them from others. For in the light' of sub- 
sequent events there were many circumstances noticed 
by his patients and others, which are only explainable 
in this way. By the autumn of 1883 his disease not 
only gave him such constant suffering, but also 
developed such symptoms as caused his advisors to 
suggest obtaining the opinion of Sir Henry Thompson. 
For this purpose he sailed for England in November, 
1883, and returned January 1, 1884, apparently much 
benefited, and much encouraged by Sir Henry's 
opinions. He again returned to active practice, and, 
although the symptoms of his disease returned, he 
managed to keep at work until the usual season of 
rest, when he sought, in a two month's residence at 
his seaside cottage at Beach Haven, to restore his 
shattered health. He, however, suffered much while 
there, not only from existing ills, but also from acute 
sickness, of a different kind, apparently malarial fever, 
and returned in the autumn worse than when he left 
the city in the early summer. He had, however, 
prepared his president's address for the annual 
meeting of the American Gynecological Society, and 
went to Chicago for the purpose of reading it. But 
while there he was forced to keep his bed during much 



158 SELECTED ADDRESSES 

of the time, although he managed to deliver the 
address. 

Returning to Philadelphia, he continued, amid un- 
speakable suffering, to attend to his practice until 
December 17th, when he did a long and laborious 
laparotomy, requiring four hours for its completion. 
On the evening of that day he sent for me to say that 
he had now given up, and would attend to no more 
business until I gave him permission. With rest, the 
severe pain with which he suffered again abated, and 
in a few days he visited relatives in New York City, 
where, however, he exposed himself unduly, and took 
cold, followed by a return of pain. He came back to 
Philadelphia the day before Christmas, 1884. With 
but imperfect intermissions to a suffering which was 
probably unsurpassed in duration and degree, he lived 
through the spring, summer, and autumn, mostly 
upon his back — as even the sitting posture increased 
his pain — reading, writing, translating, doing all that 
he and his friends could devise to occupy him, and 
make him forget his suffering. Some of his corre- 
spondence at this time is characterized by a sentiment 
and language worthy of perpetuation. His decline 
of strength was very slow, and he returned from 
Beach Haven where he spent three full months, from 
the middle of June to the middle of September, not 
very much worse than when he left home. After his 
return, however, his condition grew more rapidly 
worse, although he continued to take an interest in 
matters around him until three days before his death, 
when septic symptoms supervened, and he fell into a 
gradually deepening stupor, in which he died on the 
morning of Monday, December 14, 1885. 

An autopsy and minute study of the prostate gland 
discovered the disease to be a destructive adenoma of 
that organ. 



ALBERT H. SMITH, M.D. 159 

Dr. Smith's professional career included the experi- 
ence of a practitioner, an author, and a teacher. 

As a practitioner he was extremely popular by reason 
of his devotion and unvarying kindness to his patients, 
and his great interest in their diseases; but his highest 
skill lay, undoubtedly, in obstetric manipulations. 
In these he was facile princeps, and the comfort which 
his encouraging words and easy, confident bearing, 
gave to the family physician who sought his aid, was 
unspeakable. All difficulties seemed to vanish in his 
presence, and what seemed impossible before his 
arrival transpired with the ease of a natural event. 
His ambition, however, lay in the direction of capital 
operations in gynecology, and had he lived, and kept 
his health, it is likely that, in consequence of his 
painstaking perseverance, he would have acquired as 
much skill and reputation in this direction as in 
obstetric procedures. As it was, he did a large number 
of laparotomies with average success. At the same 
time, many of his best friends thought that in thus 
extending the field of his labors while continuing his 
enormous general and obstetrical work, he was under- 
taking more than any single individual could success- 
fully continue, and there can be no doubt that the 
fatigue incident to these capital operations, one of 
which, as has been said, occupied him for four hours on 
the day on which he finally gave up, did much to hasten 
the progress of his own malady. 

As a writer, Dr. Smith's contributions were alto- 
gether journal articles and addresses, and mainly on 
strictly practical subjects, many of them descriptive 
of appliances which he had himself devised. 

As a teacher, his strength lay, as already stated, in 
the practical character of his teachings, and the large 
amount of information he imparted, rather than in 
eloquence and impressiveness of manner. His lectures 
at the Lying-in Charity were four a week, and extended 



160 SELECTED ADDRESSES 

over three months, while additional hours were given 
in the evening to manipulative procedures. He was, 
moreover, a rapid speaker. From these facts may be 
estimated the extent of his preparations, and the 
amount of instruction he imparted. 

The attributes which characterized Dr. Smith 
during life were perseverance, thoroughness, womanly 
gentleness, and unswerving loyalty. Into what he 
undertook he threw his whole soul, and to give up un- 
accomplished anything he had attempted, seldom 
occurred to him; while there was little that he under- 
took that he failed ultimately to accomplish. In 
illustration, it may be mentioned that during the 
height of his professional career he made up his mind 
to master the German language, and, by arranging for 
lessons at very early morning hours, and seizing upon 
every opportunity, he succeeded in his object and 
became a good German scholar. 

In discussing his cherished questions, truth and pre- 
cision characterized his speech, and, although at times 
stung in debate by bitter words from those whom he 
had regarded with strong affection, and had served 
with his utmost ability, no discourteous word in reply 
ever crossed his lips. 

His gentleness was constant and unvarying, and 
extended alike to all. No one ever took a more un- 
selfish interest in his cases, or sacrificed more of per- 
sonal comfort in their behalf, while no one ever was 
more beloved in turn. No one so much occupied re- 
tained more patients whose circumstances demanded 
gratuitous attendance. No one ever rendered larger 
or more willing service to professional confreres. 

Loyalty to friends and principles had in him a true 
exemplar, and favored was the man who possessed 
his friendship; fortunate the cause which he espoused. 
The former was assured of at least one unflinching 
friend, the latter as certain of one staunch defender. 



X 

MEMOIR OF WILLIAM PEPPER, 2nd, M.D. 



a 



MEMOIR OF WILLIAM PEPPER, 2nd, M.D. 1 

From a life so crowded with events and so fruitful 
of important and wide-reaching results as that of 
Dr. Pepper, it is difficult to decide what is suitable 
for a memoir intended for preservation in the archives 
of the "College/' as well as to be read to its Fellows. 
For the former, fullness of detail can scarcely be 
excessive; for the latter, the axe of condensation 
must prune out much that would add to the interest 
of a memoir to be read in the closet. Abbreviation 
may, however, be excused when it is known that there 
will shortly be published by Professor Francis N. 
Thorpe an extended biography which will deal ex- 
haustively with Dr. Pepper's life. 

Dr. Pepper's ancestors on his father's side were 
German. His great-grandfather, Henry Pepper, emi- 
grated from Strassburg to this country as lately 
as 1739, and settled in Schaefferstown, in what is now 
Lebanon County, Pennsylvania, removing to Phila- 
delphia in 1774. His father, Dr. William Pepper, was 
the leading physician and consultant in Philadelphia 
at the time of his death at the comparatively early 
age of fifty-four. He was four years Professor of 
Theory and Practice of Medicine in the University of 
Pennsylvania, resigning in consequence of ill health. 
He was especially skilled in diagnosis based on exhaus- 
tive and accurate investigation of each case. Dr. 
Pepper's mother, Sarah Piatt, represented the fifth 
generation in descent from Thomas Piatt, whose exact 
place and date of birth are unknown, though he was 

1 Read before the College of Physicians, April 3, 1901. 

163 



164 SELECTED ADDRESSES 

born somewhere between 1685 and 1690. His son, 
Thomas Piatt, was born in Burlington County, N. J., 
in 1715. Dr. Pepper's great-grandfather, John Piatt, 
was born in the same county in 1749, but moved to 
the vicinity^of Wilmington, Del., about 1795. He 
served as a captain in the Delaware Regiment of 
Foot throughout the Revolutionary War. His son 
William, Dr. Pepper's grandfather, was also born 
in Burlington County, but was taken to Delaware when 
very young. Later he resided in Camden, N. J., and 
still later in Philadelphia, where his children, including 
Sarah Piatt, were born. 

Provost Pepper was born at 1304 Walnut street, 
Philadelphia, August 21, 1843. His youth was spent 
in Philadelphia and at his father's country-seat at 
Chestnut Hill. He was educated altogether in Phila- 
delphia, first at St. Mark's School attached to the 
parish of St. Mark's Protestant Episcopal Church, 
the head-master of which was Rev. Ormes B. Keith, 
who still lives in New York City; and later at the well- 
known Classical Academy of the late Rev. John W. 
Faries, where he was prepared for the College Depart- 
ment of the University of Pennsylvania. He entered 
the University in September, 1858, and was graduated 
Bachelor of Arts, July 3, 1862, receiving the degree of 
A. M. in Course in 1865. 

His career in college was suggestive of the bril- 
liancy of his later life. He was president of his class, 
was always an honor man, being Valedictorian, or 
second honor man, at graduation, Charles C. Harrison, 
the present Provost of the Univeristy, being the first 
honor man and Salutatorian. He was awarded the 
Senior English Prize, and equally with the late Pro- 
fessor John G. R. McElroy, the ''Philosophy Prize." 
He was a member of the Phi Beta Kappa Society, 
the members of which, it is well known, are selected 



WILLIAM PEPPER, 2nd, M.D. 165 

from those of highest standing in each class. He 
was also a prominent member of the Zeta Psi, Univer- 
sity of Pennsylvania Chapter. 

The following are among the more prominent mem- 
bers of his class at graduation: Rev. Jesse Y. Burk, 
the present Secretary of the Board of Trustees of the 
University of Pennsylvania; John Cadwalader, Col- 
lector of the Port of Philadelphia, 1885-89, etc.; 
Rev. George Stuart Chambers, D. D., a prominent 
Presbyterian clergyman of Harrisburg, Pa.; Thomas 
Mutter Cleemann, a civil engineer of prominence in 
this country and in South America; Dr. Persifor Frazer 
(D. Sci. Nat. of France), Professor of Chemistry, 
University of Pennsylvania, 1870-74; same at Franklin 
Institute, 1881-93, and same of Pennsylvania Horti- 
cultural Society, 1889 to date; geologist, etc.; Charles 
Custis Harrison, the present Provost of the University 
of Pennsylvania (see Alumni Register, July, 1900); 
Rev. John Sparhawk Jones, D. D., one of the Chaplains 
to the Univeristy of Pennsylvania, a prominent 
Presbyterian clergyman in this city; Captain Robert 
Patton Lisle, Pay Director, United States Navy; the 
late Professor John George Repplier McElroy, Profes- 
sor in the University of Pennsylvania, 1869-90; the 
late Thomas McKean, trustee, munificent donor 
to the University of Pennsylvania; the late Dr. 
George Pepper, Dr. Pepper's dearly beloved brother; 
Rev. Robert Ritchie, of the Protestant Episcopal 
Church; Skip with Winner, a distinguished lawyer of 
Baltimore. 

Immediately after his graduation in "Arts," he 
began the study of medicine with his father, then 
residing at 1215 Walnut street. He entered the Medical 
School of the University of Pennsylvania in the fall of 
1862. The Professors were Samuel Jackson, Hugh L. 
Hodge, Joseph Carson, Joseph Leidy, Robert E. 



166 SELECTED ADDRESSES 

Rogers, Henry H. Smith, and his father, Dr. William 
Pepper. He received his diploma March 12, 1864, by 
which time Drs. Jackson and Hodge had been suc- 
ceeded by Drs. Francis Gurney Smith and R. A. F. 
Penrose. The sub j ect of his thesis was : ' ' Movements 
of the Iris and Some of Their Relations." Although 
we attended lectures together for one term, 1862-63, I 
saw little of him at that time, and we first met at the 
Pennsylvania Hospital in July of the latter year, when 
I became Resident Physician at the Hospital. Dr. 
Pepper, then a student of medicine, substituted Dr. 
John Conrad, the Hospital Apothecary, who was 
taking his annual vacation. We were room-mates. 
Here began an acquaintance later ripening into a 
friendship which continued until his death. Our 
colleagues at the Hospital were Dr. Thomas Hollings- 
worth Andrews, who was substituting Dr. William 
Savery, and Dr. Horatio C. Wood, the Medical Resi- 
dent. I had myself been elected to fill the unexpired 
term of Dr. Joseph G. Richardson, resigned. The 
characteristics I recall of Dr. Pepper during this 
month or more of our residence at the Hospital were 
his cheerful, hopeful disposition, his enthusiasm and 
his alertness. He never loitered, and whether it was 
in the dispatch of his duties as Apothecary or off 
to the river in the afternoon for a row, he always 
moved quickly and gaily. He read rapidly and 
omnivorously, and among the books he read I remem- 
ber George Johnson's then comparatively new work 
on " Diseases of the Kidney." During the succeed- 
ing winter of 1863-64 he was a regular attendant on 
the clinics at the Hospital, and I recall him vividly, 
bounding up and down stairs, two and three steps at a 
time, to and from the clinics. 

In consequence of the precarious state of his father's 
health, Dr. Pepper did not enter a hospital as Resident 



WILLIAM PEPPER, 2nd, M.D. 167 

Physician immediately after graduating, but as soon 
as practicable after the elder Pepper's death, which 
occurred October 15, 1864, he became Resident at 
the Pennsylvania Hospital, and served from April, 
1865, until October, 1866. It was during this time 
that he formed his friendship with Dr. Edward 
Rhoads, whose lofty character and great ability were 
lost to the profession after a brief, but promising, 
career. Dr. Rhoads was my class-mate in the Medical 
School, and succeeded me at the Pennsylvania Hos- 
pital. During this association Dr. Pepper and Dr. 
Rhoads studied together the minute changes in the 
blood in malarial fever, and later published a paper 
on the " Flourescence of Tissues' ' in the " Pennsyl- 
vania Hospital Reports" for 1868, and in the same 
volume another "On the Morphological Changes in 
the Blood in Malarial Fever," in connection with Dr. 
John Forsyth Meigs. These papers were based upon 
the study of 123 cases of a severe form of bilious 
fever which occurred in the service of Dr. Meigs in the 
summer and autumn of 1865, and involved much 
physical and chemical research and a large amount 
of microscopical investigation. The object of the 
paper on the "Fluorescence of Tissues" was to show 
that a substance found in the normal tissues by Bence 
Jones, which possessed a property of flourescence like 
quinine, and called by him "animal quiniodine," 
disappeared under the influence of the malarial poison. 
Immediately after leaving the Pennsylvania Hos- 
pital, Dr. Pepper began practice at 1215 Walnut street, 
having been elected Curator and Pathologist, March 
26, 1866, some months before the expiration of his 
term as Resident. On January 28, 1867, the Managers 
granted him the use of a room in the Picture House, on 
Spruce street, in which to give a course of lectures on 
Pathological Anatomy. In 1867 he was elected Path- 



168 SELECTED ADDRESSES 

ologist to the Philadelphia Hospital, and, in the same 
year, one of its Visiting Physicians. In 1868 he was 
made a Lecturer on Morbid Anatomy in the Uni- 
versity. 1 He prepared while Curator a descriptive 

1 In consequence of this appointment, he gave only one or, at most, 
two courses on Pathology. The lectures on Morbid Anatomy at the 
University were given in the autumn course, preliminary to the winter 
course, by a corps of lecturers consisting of D. Hayes Agnew on Regional 
Anatomy, James J. Levick on Physical Diagnosis, H. Lenox Hodge on 
Diseases of the Skin, in addition to Dr. Pepper on Morbid Anatomy 
and myself on Microscopy. Before the course began, September 7, 
1868, Dr. Levick was replaced by Dr. Edward Rhoads. Dr. Pepper 
was made Lecturer on Clinical Medicine in 1870. Dr. Rhoads died in 
January, 1871, when Dr. Pepper was assigned to Physical Diagnosis 
and Clinical Medicine, and Dr. Joseph G. Richardson to Morbid 
Anatomy. Dr. Hodge, who had succeeded Dr. William Hunt as 
Demonstrator of Anatomy, replaced Dr. Agnew, who had become 
Professor of Clinical and Demonstrative Surgery, and Dr. Harrison 
Allen replaced Dr. Hodge as Lecturer on Diseases of the Skin. These 
constituted the lecturers in 1871. Dr. Allen gave the lectures on Skin 
Diseases for one year only, and was succeeded in 1872 by Dr. Louis 
A. Duhring. In 1873 this spring course was further enlarged by the 
addition of lectures in Practical Chemistry by the then Professor 
R. E. Rogers, on Diseases of Women and Children by Dr. William 
Goodell, on the Eye and Ear by Drs. William F. Norris and Straw- 
bridge, and on Surgical Diseases of the Mouth by Dr. James E. 
Garretson. The lectures were the last given at the old University 
buildings on Ninth Street above Chestnut. The next regular Winter 
Session of 1873-74 was given in the building of the Pennsylvania 
College, 250 South Ninth street; that of 1874-75 was the first delivered 
in the New Medical Hall in West Philadelphia. In the spring of 
1874 the lectures were given in the same building, beginning March 
30, and extending through April, May, June, and September, by the 
same men, Dr. Agnew having become Professor of Surgery in the 
Medical School. On the completion of the Hospital in West Phila- 
delphia in 1874, a Hospital Staff was appointed which included these 
men in addition to the Professors of Medicine, Surgery and Obstetrics, 
a Clinical Professor of Nervous Diseases, who was Dr. H. C. Wood, 
and a Professor of Clinical Surgery, Dr. John Neill. Dr. Tyson's 
title was changed to Clinical Lecturer on Pathological Anatomy and 
Histology. In point of fact, Drs. Stille" and Penrose, who were 
ex-officio members of the Staff, never gave lectures in the Hospital. 
Drs. Garretson and Richardson were not included in the Staff. April 
4, 1876, Drs. Neill, Goodell, Pepper, and Tyson were made members 
of the Faculty, the title of Dr. Tyson's chair being again changed to 
General Pathology and Morbid Anatomy. 



WILLIAM PEPPER, 2nd, M.D. 169 

catalogue of the pathological specimens in the Museum 
of; the Pennsylvania Hospital, covering 138 closely- 
printed octavo pages, based on one previously made 
by Dr. Thomas G. Morton. As Pathologist to the 
Philadelphia Hospital, he was the first to arrange 
systematically the making of autopsies, with a fixed 
hour for each day, and gathered materials and draw- 
ings for his lectures at the University. He devoted 
himself with his usual enthusiasm to his wards and 
to teaching in the Philadelphia Hospital until his 
extensive practice and absorbing public duties forced 
him to resign, November 24, 1884, having resigned 
the position of Pathologist to the Pennsylvania 
Hospital in 1871. 

In 1870 he became Lecturer on Clinical Medicine 
in the University of Pennsylvania, and in 1876 Pro- 
fessor of that branch, holding this position until 1884, 
when he was chosen Professor of Theory and Practice 
to succeed the late Dr. Alfred Stille. In the mean- 
time, in 1881, he had become Provost of the Univer- 
sity, retaining this office until 1894. 

Dr. Pepper took an active interest in many of the 
medical societies of his city, State and country. Nat- 
urally, the Pathological Society was his first field, as 
it was that of Gross, of Still6, of Da Costa, and of 
Ashhurst. He became a member in 1865, and at once 
its leading member. He was chosen Vice-President 
in 1870, and was its President from 1873 to 1876. He 
was made a Fellow of this "College" in 1867, and im- 
mediately took an active part in its proceedings. His 
most important papers were " Trephining in Cerebral 
Disease," read May 18, 1870; "The Internal Use of 
Nitrate of Silver," read May 7, 1877, and "Addison's 
Disease," read January 7, 1886. In addition to these 
papers, his remarks on the communications of other 
Fellows were always full of valuable information, 



170 SELECTED ADDRESSES 

gained largely from his own experience. Thus, suc- 
ceeding a paper read by J. Ewing Mears, on " Encysted 
Dropsy of the Peritoneum/' although Dr. Pepper had 
only been eleven years in practice, he cited three cases 
of the comparatively rare condition which had oc- 
curred in his own experience. Thus it was with every 
subject which came up when he happened to be pres- 
ent. In consequence of the exacting demands on his 
time by the numerous and important interests in 
which he was concerned in recent years, he was com- 
pelled, much to his own regret, to neglect the meetings 
of the "College," but he always took a warm interest, 
and I know, from personal knowledge, looked forward 
to the time when, freed of some of his responsibilities, 
he might again contribute to its proceedings and take 
a hand in its management. It was through his in- 
strumentality chiefly that in 1870, three years after 
his election to Fellowship, the " College," for a time, 
increased its meetings to two a month, with the idea 
that one meeting should be devoted to scientific 
matters only, and the other to business. At that day, 
however, the number of Fellows was much smaller 
and there was much less activity among them, so that 
the semi-monthly meetings could not be kept up. 
Quite recently, when it appeared to some of us that the 
time had come for the formation of a Section on 
Medicine for the purpose of stimulating this depart- 
ment, Dr. Pepper attended the meeting for organiza- 
tion, in January, 1897, though he was at the time 
overwhelmed with work and broken in health, and 
had not for a long time attended a similar meeting. 
This was the last meeting of a medical society he ever 
attended. 

He was one of the founders of the Obstetrical Society 
in Philadelphia, in 1869, but was never active in its 
work, as he never practiced midwifery. He became a 



WILLIAM PEPPER, 2nd, M. D. 171 

member of the Philadelphia County Medical Society 
in 1871, of the American Medical Association in 1872, 
and of the Medical Society of the State of Pennsyl- 
vania in 1875, and in the early part of his career was 
a frequent contributor to their Proceedings. He de- 
livered the address in Medicine before the State 
Medical Society at its meeting in Potts ville, in 1875, 
which at once charmed and astonished the older 
members, for he was then but thirty years of age. 
He was Chairman of the Committee of Arrangements 
of the American Medical Association at its meeting 
in Philadelphia, in 1876. He was one of the founders 
of the Climatological Society in 1884, and its President 
in 1886; also one of the founders of the Association 
of American Physicians in 1886, and its President in 
1891. He was the first President of the Pan-American 
Medical Congress, at its organization in Washington 
in 1893, and delivered an able and most impressive 
address, which was listened to with rapt attention by a 
large audience made up of delegates and their friends, 
from Mexico, South America, the West Indies, Canada 
and the United States. Its subject was "The State 
of this Continent and its Aboriginal Inhabitants at 
the Time of its Discovery by Columbus, and the Ob- 
stacles which Opposed Him and the Great Men who 
Completed His Work," together with "The State of 
Medical Science in Europe at the Time of the Discov- 
ery, and the Spirit which Controlled its Subsequent 
Course." It abounds in valuable information, in- 
volving laborious historical research, gathered and 
collated at a time when he was excessively busy. It 
excited the enthusiastic admiration of the representa- 
tives from British and Spanish America, which was 
reflected in the reception given him in the city of 
Mexico at the Second Triennial Meeting of this Con- 
gress in 1896. The Pan-American Congress itself 



172 SELECTED ADDRESSES 

owes its existence to Dr. Charles A. L. Reed, of Cin- 
cinnati, who introduced a resolution creating it at the 
meeting of the American Medical Association at 
Washington, May 5, 1891. Dr. Reed was made 
chairman of the preliminary organization. In the fall 
of 1891 Dr. Pepper was unanimously elected President, 
and Dr. Reed was chosen Secretary-General of the 
first Congress, which it was decided to hold in Wash- 
ington, D. C. Dr. Pepper threw himself energetically 
into the work, and was instrumental in securing an 
appropriation from Congress toward the expenses of 
the meeting. At its inception he had few sympa- 
thizers, but, like all else he undertook, he made the 
Washington meeting a magnificent success, as the two 
splendid volumes of nearly 1200 pages each, which con- 
tain the Transactions published in English and Spanish, 
abundantly attest. They include a vast amount of 
information bearing on Medicine from all parts of 
North and South America, which could in no other 
way have been accumulated. Dr. Pepper remained 
Chairman of the International Executive Commission, 
which is the permanent body of the Congress, until 
his death. As Chairman of this Commission he at- 
tended the second Congress, held in the city of Mexico, 
November 15-19, 1896, delivering an address in the 
National Theatre on the evening of November 16. He 
received much attention while in Mexico, and was 
especially honored by President Diaz. A fitting 
termination of the relation established with Mexico 
was a memorial meeting, held September 12, 1898, 
in the city of Mexico, in the National Chamber of 
Deputies. President Diaz presided, while about him 
were gathered cabinet officers and other government 
officials, the principal citizens, scientists and physi- 
cians of the republic. The first address was by Hon. 
Matias Romero, the Mexican Minister to the United 



WILLIAM PEPPER, 2nd, M.D. 173 

States, who eulogized Dr. Pepper as an altruist who 
had sacrificed himself for the good of his fellow-men. 
Dr. Porfirio Parra spoke, in behalf of the National 
Medical School, of Dr. Pepper's medical life; Dr. Arel- 
lano, in behalf of the Board of Health, of his social 
and humane qualities, and Dr. Mendizabal concluded 
by a glowing eulogy, in which he summed up Dr. 
Pepper's life-work. The occasion was rendered more 
impressive by appropriate music. 

Among the first of Dr. Pepper's important works 
was the founding, in 1870, of the Philadelphia Medical 
Times. He secured a guarantee fund, chiefly from 
members of the profession, from which was made up 
for three years any loss sustained by its publishers. 
The first number was issued October 1, 1870. First 
a semi-monthly, it became later a weekly, and although 
it has been discontinued for some years, the journal 
contained the best literary productions of such men 
as S. D. Gross, Alfred Stille, D. Hayes Agnew, John 
Forsythe Meigs, J. M. Da Costa, R. J. Levis, William 
Goodell, Addinell Hewson, James H. Hutchinson, 
John Ashhurst (Jr.), Harrison Allen, S. W. Gross, 
Frank Maury, John S. Parry, George Pepper, William 
Pepper, and others who have passed over into the un- 
known country. An examination of the early volumes 
shows that its publication marks an era in the medical 
activity of Philadelphia, whence we may date the 
extraordinary development of medical education which 
has characterized the last thirty years of the century 
just closed. Dr. Edward Rhoads was to have been 
the editor, but his failing health permitted only the 
preparation of the first number. I have elsewhere 
said that Dr. Pepper edited the journal for two years, 
and am sure he edited for several months, but was sur- 
prised on taking down the first volume to find that 
the editor was James H. Hutchinson, and associate 



174 SELECTED ADDRESSES 

editor James Tyson. I had forgotten how close was 
my own relation to the journal. 

The removal of the Medical News to New York, in 
1896, left Philadelphia without a first-class medical 
weekly journal. Dr. Pepper felt this was a serious 
deficiency in a city which had always taken such a 
prominent position in matters medical, and was rest- 
less under this feeling. Early in the fall of 1897 he 
began to organize a company for the purpose of es- 
tablishing a journal which would fill this gap. With 
his usual broad and liberal views, he sought to interest 
not one, but all the medical schools of Philadelphia, 
and not only succeeded in this, but secured also the 
interest of prominent business men other than pub- 
lishers of medical books, including those of large ex- 
perience in the management of successful newspapers. 
By October 1, 1897, the arrangements were completed, 
a board of trustees appointed, and Dr. George M. 
Gould appointed editor, with an executive committee 
representing all interests to co-operate with him. On 
Saturday, January 1, 1898, appeared the first number 
of the Philadelphia Medical Journal, which promptly 
established itself in the front ranks of the medical 
journals of the world, and by its example has elevated 
medical journalism in America to a plane it would 
not have reached for many years, if at all. 

The very first of the enduring works of Dr. Pepper, 
characterized by its magnitude and importance was 
the founding and completion of the Hospital of the 
University of Pennsylvania. Initiated by a com- 
mittee from the Society of the Alumni of the Medical 
Department, March 14, 1871, on the motion of Dr. 
William F. Norris, it involved securing from the city, 
at a nominal cost, a tract of land worth, at least, 
$200,000, an appropriation of $100,000, and again 
$100,000 from the State, in addition to the raising by 



WILLIAM PEPPER, 2nd, M.D. 175 

subscription of $350,000 for endowment, and was 
completed in its first stage by appropriate ceremonies 
of inauguration held at the Hospital June 4, 1874. 
Subsequent stages included the addition of the Gibson 
Wing, rendered possible by the generosity of the late 
Henry C. Gibson, stimulated by the persuasion of 
Dr. Pepper, whose efforts also secured a liberal endow- 
ment for the same; the Maternity Hospital and 
Agnew Pavilion, in behalf of the latter of which he 
again successfully invoked the aid of the State, while 
his own purse completed the conditions that made it 
possible. 

The Hospital had barely reached the first stage of 
its completion before another permanent institution 
of great and growing importance received his atten- 
tion — The Pennsylvania Museum and School of In- 
dustrial Art, and I well remember the bright afternoon 
in June, 1875, when we parted at the railway station 
in Pottsville, he to return to Philadelphia to take part 
in the first meeting for the organization of the Museum 
and I to the sessions of the State Medical Society which 
were not yet concluded. He did not, however, con- 
tinue long associated with it, and went on the Board 
of Trustees for one year only, finding himself deeply 
involved in work, much at this time growing out of 
his appointmeut as Medical Director of the Interna- 
tional Exposition, commonly known as the " Cen- 
tennial," which was to be opened in Philadelphia the 
next year. He supervised the sanitary arrangements 
of the Fair, and organized a medical corps for the 
treatment of emergencies. For his distinguished 
services in this connection he was decorated by the 
King of Sweden Knight Commander of the Order 
of St. Olaf, and received recognition also from the 
English Government. 

At this time (1876) the Medical Faculty of the 



176 SELECTED ADDRESSES 

University was enlarged by the addition of Professor- 
ships of Clinical Surgery, Clinical Medicine, Clinical 
Diseases of Woman and Children, and General Path- 
ology and Morbid Anatomy, to which Drs. John Neill, 
William Pepper, William Goodell and James Tyson 
were respectively appointed. Simultaneously, the 
important step of prolonging the Medical Course from 
two to three years was also under consideration, and 
in it Dr. Pepper was naturally most active. The 
plan was consummated early in 1877, and inaugurated 
by his notable address, delivered October 1, 1877, 
entitled " Higher Medical Education the True Interest 
of the Public and the Profession." Closely followed 
the foundation of the Dental Department of the Uni- 
versity, in 1879, and the construction and furnishing, 
at a cost of $90,000, of the Laboratory Building, in 
which were accommodated the Laboratories of Chem- 
istry and Dentistry and the Dissecting Room. The 
Veterinary Department of the University was estab- 
lished through his efforts in 1884, and in the same 
year the Biological School and the Course Preparatory 
to Medicine in the College Department. 

The Laboratory of Hygiene was conceived by him, 
and though rendered possible by the munificence 
of Mr. Henry C. Lea, his influence with Mr. Lea went 
far to secure it, while the conditions of the latter's 
gift involved the raising of $200,000 for endownment, 
also collected through the efforts of Dr. Pepper. It 
was completed in 1891. Close on this followed the 
prolongation of the Course in Medicine from three 
years to four and the magnificent gift of $50,000 to 
secure its consummation. The Wistar Institute of 
Anatomy, the gift of General Isaac Wistar, General 
Wistar himself tells us, was the result of conviction 
through Dr. Pepper's efforts that it would serve a 
useful purpose in the teaching of anatomy and the 



WILLIAM PEPPER, 2nd, M.D. 177 

development of anatomical knowledge, as well as a 
storehouse for the famous museum inaugurated by 
his distinguished ancestor, Dr. Caspar , Wistar. It 
was commenced June 10, 1892, and finished May 3, 
1893. These acts, more particularly associated with 
the Medical Department, culminated in 1895 with 
the erection and partial endowment of the William 
Pepper Laboratory of Clinical Medicine, as a memorial 
to his father, Dr. William Pepper, and his brother, Dr. 
George Pepper. 

The handsome and commodious Library of the 
University of Pennsylvania was built under the in- 
spiration of Dr. Pepper, from plans by Frank Furness, 
with a capacity for 275,000 volumes within its fire- 
proof walls. It is equaled by few college libraries 
of the world, and compares well with many municipal 
and national library buildings. The corner-stone 
was laid October 15, 1888, and it was completed 
during the summer of 1890, at a cost of $200,000, 
largely aided by Dr. Pepper's efforts. It was formally 
opened to the public, Saturday, February 7, 1891. 

Some allusion should be made to Dr. Pepper as 
an author and a teacher. Reference has already 
been made to many of the papers and addresses 
which he prepared. Among others should be men- 
tioned papers on " Phosphorous Poisoning' ' and 
" Variola," published in 1869; "Tracheotomy in 
Chronic Laryngitis," "Abdominal Tumors," "Trephin- 
ing in Cerebral Disease" and "Progressive Muscular 
Sclerosis," in 1871; "Local Treatment of Tuberculous 
Cavities" and "Operative Treatment of Pleural 
Effusions," in 1874; "Sanitary Relations of Hos- 
pitals" and "Progressive Pernicious Anemia," in 
addition to the address before the State Medical 
Society already mentioned, in 1875; " Cheyne-Stokes 
Breathing in Tubercular Meningitis," in 1876. In 
12 



178 SELECTED ADDRESSES 

1883 he read one of his most noteworthy papers 
before the State Medical Society at its meeting at 
Norristown. It was entitled a " Contribution to the 
Clinical Study of Typhlitis and Perityphlitis." In 
it he first called attention to the relapsing feature of 
appendicitis, and reported several cases. Although 
the importance of early surgical treatment was not 
appreciated at that day, and although prolonged 
medical treatment was recommended where at the 
present day surgical interference would be promptly 
made, the present practice was foreshadowed in the 
following paragraph: "The operation is so simple, 
and, if properly performed, so free from danger or 
complications, that is to be hoped that hereafter 
the indications for its performance will be more 
clearly recognized and more constantly borne in 
mind, not by surgeons only, but by the general prac- 
titioners under whose care such cases come, and by 
whom the necessity for the operation must be recog- 
nized, even if they prefer to call in a consulting sur- 
geon for its performance. " The following paragraph 
points in the same direction: "It is not too much to 
say, that the unjustifiable delay permitted in many 
cases of typhlitis, whilst hoping day after day for the 
more definite detection of suppuration, is the direct 
cause of many avoidable deaths." 

In 1870 was published his revision of Dr. John 
Forsyth Meig's work on "Disease of Children," long 
familiarly known as "Meig and Pepper on Children," 
In 1886 he published, in connection with Guy Hins- 
dale, "A Climatological Study of Phthisis in Pennsyl- 
vania." He is widest known as an author from his 
editing "A System of Medicine by American Authors," 
better known as "Pepper's System of Medicine," pub- 
lished in 1885, one of the most successful publications 
ever issued from the American medical press. He 






WILLIAM PEPPER, 2nd, M.D. 179 

wrote the articles on " Catarrhal Pneumonia" and 
" Relapsing Fever/ 7 for the study of which in Phila- 
delphia he had peculiar facilities in 1866. " Pepper's 
Text-Book of Medicine by American Teachers" was 
published in 1893-94, and was immediately successful. 

As a teacher, Dr. Pepper's greatest power lay in 
the clinical lecture. He was rapid in his examination 
of a case, quickly recognized distinctive features and 
promptly drew conclusions, was at times almost intui- 
tive in his diagnosis, a great contrast in this respect to 
his father, who was a laborious and exhaustive inves- 
tigator who seldom erred. In addressing students 
he was impressive and authoritative, and they as 
well as patients remembered when he enjoined. His 
prescriptions were simple, but his directions were 
explicit and emphatic. As a practicing physician 
he was hopeful and encouraging — according to the 
views of some, too much so — but his encouraging 
opinions were the natural result of his hopeful nature, 
and not assumed. He could not take a discouraging 
view of anything. They served to make the last 
hours of many a poor sufferer comfortable and tran- 
quil, although they sometimes sorely disappointed 
afflicted friends. 

On the twenty-second of April, 1894, I received the 
following short note from Dr. Pepper: 

"Dear T. : — The winter's work has been so hard 
that I cannot bring myself to face another like it. 
Everything is in good shape, and I propose, therefore, 
to cut the Gordian knot to-morrow, and want you to 
have early information of it. 

"Yours sincerely, 

"W. P." 

On the next day he sent to the Board of Trustees 
his resignation of the Provost's office, from which I 
extract these paragraphs: 



180 SELECTED ADDRESSES 

"With deep thankfulness I recognize that the 
University has reached a stage of development and 
prosperity which justifies me in laying down the high 
office you entrusted to me more than thirteen years 
ago, and which I held as long as it was possible to 
combine the administrative labors of Provost with the 
demands of medical teaching and practice. This 
time has now passed, and I beg therefore to tender 
my resignation, to take effect after the coming 
Commencement . 

"The close of the coming session will witness 
the completion of the formative period of the Uni- 
versity. From a group of disconnected schools there 
has been gradually organized a great academic body, 
complete in its unity and instinct with varied, yet 
harmonious activities. Mutual confidence and co- 
operation have developed a system strong enough for 
effective central control, yet so flexible as to admit 
affiliation with many separate organizations. 

"To our University is due the credit of establishing 
university extension in America, yet the important 
and successful society which controls this movement 
has no organic relations with the University, save 
that the Provost is ex-officio the Honorary President." 

Some idea of what was accomplished during the 
period of his Provostship may be gathered from the 
following: 

In 1881, when Dr. Pepper became Provost, its 
property was fifteen acres; at his resignation there 
were owned or controlled by it, in a continuous tract 
and solely for educational purposes, not less than fifty- 
two acres. The value of the lands, buildings and 
endowment in 1881 was estimated at $1,600,000; 
in April, 1894, it was over $5,000,000. Prior to the 
date of the late Henry J. Towne's great bequest, the 
University had never received a single large gift or 



WILLIAM PEPPER, 2nd, M.D. 181 

legacy. During the year ending September 1, 1894, 
there were acquired in lands, buildings, money and 
subscriptions not less than $1,000,000. The members 
of the teaching force in 1881 numbered 88, and the 
students in all departments 981; at the date of his 
resignation the former were 268 and the attendance 
had reached 2,180, representing every state of the 
Union and no less than thirty-eight foreign countries. 
The College Department had attained a national dis- 
tinction. The Medical School had been advanced to 
pre-eminence in equipment and prosperity, while plans 
were maturing destined to place it abreast of the great 
schools of Europe. The Law School had effected a 
prolongation and elevation of its curriculum, and had 
acquired national reputation, while progress had 
been made toward providing a magnificent build- 
ing, which has since been completed. The Dental 
and Veterinary Departments were in successful opera- 
tion, and plans for their further development were 
matured. The Department of Philosophy had been 
organized in 1884 and had 154 students, extending 
the privileges of the University to women on equal 
terms with men. The necessity of dormitories to the 
highest development of the University had been 
recognized, and their ultimate erection was assured. 

Dr. Pepper has resigned the Provostship, but not 
to rest. His restless energy knew no bounds, and is 
well expressed by his own motto — Repos ailleurs — 
rest elsewhere. No sooner had one undertaking been 
accomplished than another was launched, another, and 
another. Four of these needed his developing guid- 
ance a while longer, and were furtunate to receive 
it as long as required. They were the Department 
of Archaeology and Paleontology of the University 
of Pennsylvania, which he had created in 1891, and 
of which he became President in 1894; the Museum of 



182 SELECTED ADDRESSES 

Science and Art, the Commercial Museums of 
Philadelphia, and the Free Library. It is impossible 
in a memoir like this to give an adequate idea of the 
labor involved in maturing these projects. I saw 
much of him and thought myself familiar with his 
work, but had no conception of its extent until after 
his death. 

The picturesque and imposing Museum of Science 
and Art was his conception, and was rendered neces- 
sary to house the rapidly growing collections of the 
Department of Archaeology and Paleontology. Origi- 
nally, a complete museum building was projected, 
to cost only $150,000, but at Dr. Pepper's suggestion 
a plan for a more extensive and more imposing struc- 
ture was adopted. The completed scheme involves 
a building to cost from $2,000,000 to $2,500,000, 
including an imposing dome which forms a natural 
completion to the present wing. The estimated cost 
of the dome alone is $125,000. The building, so far 
as constructed, was built at a cost of $385,000, and 
Dr. Pepper himself was the largest subscriber after the 
State of Pennsylvania, which appropriated $150,000. 
It was not finished until after his death, and was 
formally opened with appropriate ceremonies Decem- 
ber 20, 1899, at which time also the monument to 
Dr. Pepper was presented to the University. It was 
cast in bronze from designs by Karl Bitter, and stands 
on a pedestal designed by Leigh Hunt on an elevated 
portion of the grounds adjoining the Free Museum, 
overlooking many of the buildings which his energy 
and generosity created. On the same occasion his 
widow, Frances Sergeant Pepper, presented $50,000 
as an endowment for the William Pepper Hall of the 
Museum. In behalf of the precious collections them- 
selves, his efforts were untiring and extended. As 
President of the Department of Archeology and Pale- 



WILLIAM PEPPER 2nd, M.D. 183 

ontology, he established relations with other institu- 
tions — with Harvard University, the Smithsonian 
Institution and Bureau of American Ethnology at 
Washington, the Egypt Exploration Fund and the 
Egypt Research Society in England. The Presidency 
of the Pennsylvania Branch of the Archaeological 
Institute of America, and the founding of the Ameri- 
can Exploration Society, the influencing of legislation 
in the city and state and national legislatures, the 
securing of land and the raising of lavish sums of 
money for the furthering of exploration were all con- 
ditions of success in the great movement. All these 
he undertook and accomplished. 

The idea of the Commercial Museums of Phila- 
delphia originated with Professor William P. Wilson, 
who was sent by the city of Philadelphia to the 
World's Fair in Chicago in 1893, commissioned to 
lay the plans of the institution before the ambassa- 
dors, ministers and representatives of the foreign 
countries there exhibiting. Dr. Pepper was, how- 
ever, early conferred with, and promptly threw his 
whole soul into the work, giving several hours daily 
for many weeks. The result was not only a museum 
of the kind described, but "an organization most 
complete and systematic for the distribution of com- 
mercial information and the methodical study of 
universal commerce.' ■ It involved extensive rela- 
tions with government officials and the representa- 
tives of foreign nations, including the organization 
and guidance of an International Congress. To the 
success of these measures the fascination of manner 
and energy of purpose which always characterized 
him contributed greatly. 

It is not impossible that, measured by its far- 
reaching influence and the breadth and depth of the 
intellectual development it fosters, the Free Library 



184 SELECTED ADDRESSES 

of Philadelphia may become the greatest of all the 
monuments to his zeal, his energy, his inspiring 
example. " A library in which every man, woman, or 
child of proper age can have as ready access to its 
books as they can have to the few volumes stored 
upon the shelves in their own homes/ ' he said, "is a 
necessity. " For this he secured legislation from 
city and state, providing for its growth and support. 
For this he not only secured priceless gifts of books 
and money, but also convinced the rich that it was 
their privilege to devote their wealth, and even 
costly residences, to the service of this magnificient 
purpose. For this on Sunday afternoons and even- 
ings, as well as on weekdays amid his multifarious 
engagements, he addressed, in different parts of the 
city, interested gatherings of men and women. For 
this and like objects also he sacrificed his life on the 
altar of his splendid purposes. 

It was Dr. Pepper's habit to cast about him for the 
public work which most needed stimulating, devot- 
ing his attention to it until it was thoroughly on its 
feet and then passing on to another. Had he lived, 
the Philosophical Society to which he was elected in 
1870 would certainly have profited by his touch, he 
having been chosen Vice-President in January, 1896. 
The historic College of Physicians, under the lead of 
Stille, Agnew, Weir Mitchell and Da Costa, did not 
require his efforts, and he wisely directed them else- 
where. 

Evidences of failing health presented themselves 
even prior to the winter of 1896-7, when he had one or 
two attacks of grippe, which always affected him 
severely, and he was compelled to go South for a 
time to secure needed rest. In the summer of 1897 he 
went to California and was absent for two months, 
during which he greatly improved and returned re- 



WILLIAM PEPPER, 2nd, M.D. 185 

freshed and invigorated. He plunged actively into 
work, the Loan Bill and legislation in behalf of the Free 
Library claiming much attention in addition to the 
work of the Museums and the demands of his large 
consulting and office practice. Early in January, 
1898, he had an attack of influenza associated with seri- 
ous bronchitis and troublesome cough. This pros- 
trated him greatly, and although he improved enough 
to go to work for a little while, he soon broke down 
again, and after he had improved sufficiently to do so, 
went South for several weeks. He returned benefited, 
but with health still shattered. During the month of 
June, 1898, he was far from well, but kept more or 
less at work in spite of several anginoid attacks. His 
family were at Bay Head, N. J., but he could not re- 
main there. His precordial oppression seemed worse 
there. There was sometimes edema. Once he went 
to New York City, hoping that at the top of one of the 
many-storied buildings he would be more comfortable. 
I saw him last in July, 1898. I was coming out of my 
house when he drove up and sprang lightly from his 
carriage, just as he did in perfect health. We walked 
together up Spruce street, chatting and joking, until 
we arrived at the corner of Eighteenth street, when he 
left me, gaily running across the street to his house. 
He could not go slowly. I never saw him again. On 
the seventh of July he left for California and was very 
ill on the day of his leaving. He had an obstinate 
spell of vomiting in his office and reached the train with 
difficulty. In Chicago he was desperately ill. Dr. 
Alonzo Taylor, who was with him, told me he thought 
he would die at his hotel. By the free hypodermic use 
of strychnine and digitalis, however, he was tided over 
this danger and crossed the mountains safely to the 
home of his friend, Mrs. Phoebe A. Hearst, where he 
died suddenly in an attack of angina July 28. He had 



186 SELECTED ADDRESSES 

been reading Stevenson's " Treasure Island" and died 
with a copy of the book in his hand. He would have 
been fifty-five years old on August 21. 

An autopsy was made, for the record of which I am 
indebted to Dr. Alfred Stengel: "The valves of the 
heart were healthy, but the coronary arteries were 
in an advanced state of sclerosis with consequent 
disease of the myocardium. The right coronary was 
almost completely occluded at one point by an area 
of especially intense disease and by a partially organ- 
ized thrombosis within. There was some atheroma of 
the aorta and of the general arterial system throughout 
the body. The liver was highly sclerotic and the 
kidneys showed the effects of the cardiac failure, being 
swollen and highly degenerated. The apex of the 
left lung was greatly puckered and retracted, and im- 
bedded in the fibrous tissue which caused the contrac- 
tion, were found several small, cheesy foci. These 
were undoubtedly remains of the tuberculous infection 
from which he had suffered many years before, and 
which was thus evidently wholly cured. The arteries 
of the circle of Willis were sclerosed and calcified in a 
most remarkable manner. Several of the branches 
were almost completely occluded and none of them 
was seemingly of more than half its previous or normal 
calibre. There was no gross change in appearance in 
the cerebral substance. The brain was considerably 
above the average in size." 

More useful than to relate the events of a life, how- 
ever important these, is it to picture the qualities 
which lie at the foundation of its success and constitute 
the spring of its action. What was it in Dr. Pepper 
that made him what he was; that secured his success 
in organization, in financing and in originating and 
completing great and useful undertakings? First of 
all, his undying hopefulness and his unwearying energy, 



WILLIAM PEPPER, 2nd, M.D. 187 

which, as I have said, knew no bounds, scarcely knew 
fatigue, and were never discouraged by defeat. De- 
feat he met, but never discouragement, while the bit- 
terness of heart which so often follows it found no place 
in him. 

Of undoubted influence, also, was his refined and 
inspiring manner, which attracted all who fell within 
its influence. About five feet ten inches in stature, of 
late years he had a slight stoop, which was not ungrace- 
ful; his prominent nose did not detract from his hand- 
some face and winning smile. His habit was, espe- 
cially at the first meeting, to look at one with raised 
eyes, continuing his gaze intently for a short time. 
His ability to enlist the interest of others lay largely 
in these qualities, which were increased by an earnest, 
persuasive speech and a quiet voice. He has been well 
characterized as a " delicately aggressive." 

His power of rapid thought and prompt conclusion 
greatly facilitated his conduct of affairs and enabled 
him to consider two or three matters at one time, 
though he sometimes gave offence in this way to 
individuals who considered they should have his un- 
divided attention. Some of his most important 
plans were evolved under such circumstances. 

Another factor which contributed to his success 
was his own personal liberality in fostering the proj- 
ects he started. He himself had simple tastes, and, 
although he provided himself with all that was neces- 
sary to enable him to take care of his health while 
traveling, he was simple and unostentatious in his 
habits. But he gave liberally of his means to public 
undertakings and by his example stimulated others 
to a like liberality. He sought profitable investments 
and worked hard in his profession to make money, 
but it was not for himself that he did it. It was 
that he might lay it out for the advantage of others. 



188 SELECTED ADDRESSES 

He is said to have given nearly half a million dollars 
of his own earnings to the various institutions in 
which he was interested, and to have raised ten 
millions more. He secured from the city of Phila- 
delphia, at one time or another, a hundred acres of 
land in what will probably ultimately be the heart 
of the city. 

It was impossible for a man of Dr. Pepper's far- 
reaching activity and success to be without enemies 
and detractors. Causeless hostility and detraction 
arise variously in accordance with individual traits, 
the sum of which constitute the opposite of magna- 
nimity. Such persons may be haunted by imagined 
wrongs or aggrieved by disappointed expectations and 
baffled efforts. Some are more or less the critics of 
all who succeed, others of those whose methods do not 
concur with their own. The deportment of Dr. 
Pepper to his enemies was one of the most distinctive 
features of his character. An eminent writer has 
said of him: "No characteristic of this extraordinary 
man is more prominent than his genius for treating 
enemies like friends. Seldom has a man been born 
into the world so free from the capacity for jealousy, 
envy, hatred or malice/' 1 This is strictly true. I 
never knew him to speak an unkind word of one of his 
enemies. He acted as though unconscious of their 
efforts, while fully aware of them. The importance 
of such qualities to one who is constantly originating 
great undertakings which require the influencing of 
legislation and the reconciliation of opposite factions 
is evident. It is so natural to feel aggrieved and 
resentful, for a time, at least, under disappointment 
and unfair dealing, that extenuation may be allowed. 



1 Francis Newton Thorpe, in "A Remarkable American," Century 
Magazine for February, 1901. 



WILLIAM PEPPER, 2nd, M.D. 189 

Extenuation was not, however, necessary in his case, 
he was so entirely free from resentment. 

It is difficult at so early a date after death to place 
a correct estimate upon the importance and usefulness 
of any life, and it is perhaps better always to defer the 
effort at such an estimate until time has eliminated 
all personal relations by the death of friends and critics 
alike. If we look around us, however, at the institu- 
tions which originated through his efforts, or developed 
through his touch from their original beginnings, the 
most conservative judgment must admit that his 
name should be linked with that of Benjamin Franklin, 
Benjamin Rush, Robert Morris and Stephen Girard 
as eminent benefactors of his native city. 



XI 
ADDRESS ON PRESENTATION OF POR- 
TRAIT OF DR. WILLIAM W. GERHARD 
TO THE COLLEGE OF PHYSICIANS 

1897 



XI 

ADDRESS ON PRESENTATION OF THE 
PORTRAIT OF DR. WILLIAM W. GER- 
HARD TO THE COLLEGE OF PHYSI- 
CIANS OF PHILADELPHIA, WEDNES- 
DAY EVENING, JUNE 2D, 1897 

Mr. President and Fellows of the College: — 

I count it no small privilege to be permitted to pre- 
sent the portrait of Dr. Gerhard. To have known 
Gerhard, to have attended his Clinics, to have followed 
him in wards, to have been the subject of his humor 
and of an amusing quizical gaze, are reparation to me 
for being no longer allowed to call myself one of the 
younger Fellows of the College. For had I been 
much younger I could not have known him. 

He died April 28th, 1872, and for several years 
prior to his death he lived in the forced retirement of 
invalidism. Though he was not quite 63 at his death, 
he seemed older. 

The portrait resembles Dr. Gerhard as I remember 
him, but no portrait can do him justice. His tall 
spare form and not unbecoming stoop, his prominent 
eyes and the thick convex lenses in his spectacles, all 
who ever saw him remember. But his perpetual 
facetiousness, his disposition to poke fun and the com- 
ical way in which he held his cane in front of him can 
only be recalled by one who knew him. Even one 
who knew him could never be quite certain whether 
the Doctor was in earnest or not, he was so constantly 
joking. So, at least, it was while I knew him. His 
habit of addressing the students who sat on the front 
benches in the amphitheatre as victims of malaria 
was alarming and disconcerting to the tyro, but the 

13 193 



194 SELECTED ADDRESSES 

older men soon learned to understand the joke and to 
enjoy it. 

Dr. Gerhard was a great clinical investigator and 
teacher. By some of his admirers he is thought to 
have been the greatest clinician this country has ever 
produced. Be that as it may his name is coupled with 
a clinical event which must be associated in importance 
with the discovery of vaccination by Jenner, viz: the 
distinction of typhoid from typhus fever, based upon 
studies, first in Paris under Louis and again in the 
wards of the Philadelphia Hospital, in conjunction 
with Caspar W. Pennock — and announced in 1837. 
It was in 1832 and '33 that he studied under Louis, 
who had published his celebrated work on Typhoid 
fever, in 1829, succeeding which students flocked to 
his teachings from all parts of the world. Among 
these was the brilliant coterie of young Americans 
including Gerhard, James Jackson of Boston, and 
Pennock. With Louis, too, he made those studies in 
Auscultation and Percussion which were the founda- 
tion of his undisputed preeminence for so many years 
in the Diagnosis of Diseases of the Chest. Of his book 
on this subject he published the first edition in 1835, 
enlarged to include symptomatology and treatment 
in subsequent editions, the last of which (the 4th), 
appeared in 1860. Laennee invented the stethoscope 
in 1816; Charles J. B. Williams published his book 
"A Rational Exposition of the Physical Signs of the 
Diseases of the Lungs and Pleura" in 1828; that on 
"Diseases of the Chest" in 1835; Walter Hayle Walshe 
his book on "The Physical Diagnosis of Diseases of 
the Lungs" in 1843. Thus it will be seen how much 
a pioneer on this subject was Gerhard. The novelty 
of these subjects when he taught them, together with 
the ability and zeal of the young teacher made his 
lectures most popular, and it is not surprising that 



WILLIAM W. GERHARD, M. D. 195 

students flocked to hear him, first at the Philadelphia 
and then at the Pennsylvania Hospital. When I 
came to reside at the latter Hospital, however, in 1863, 
his brilliant teaching days were over and he is better 
remembered by resident physicians of that day for 
his sallies of wit and humor than for serious clinical 
teaching. 

It may not be amiss to allude here briefly to the 
methods by which he arrived at his conclusions and 
some of the results he accomplished. He made 
morbid anatomy the basis of his studies. He observed 
closely the morbid conditions in each case and re- 
frained from comparing his results with those of others; 
nay, more, he did not even compare his own findings 
with each other until he had completed his observa- 
tions. Then he drew his conclusions. Thus he gave 
his work a practical stamp which it always retained. 
In addition to the great work on typhoid fever and 
typhus, and diseases of the chest, he showed how men- 
ingitis and tuberculosis of the membranes of the brain 
in children were associated, but he did not at that day 
pretend to say which was the primary affection. He 
pointed out the peculiar features of the pneumonia 
of children, especially the fact that the pneumonia 
was lobular rather than lobar, the most striking feature 
by which it is to-day known. He studied, with Pen- 
nock, Asiatic Cholera as it appeared in Paris in 1832, 
small pox at the same time, and the morbid anatomy 
of intestinal diseases in children, in whom he found 
that the glands of Peyer were sometimes involved, 
as he thought, in other diseases than typhoid. Later 
he pointed out the true nature of the epidemic of 
cerebro-spinal meningitis, or " spotted fever," as it 
appeared in 1863 in Philadelphia. His last important 
paper was that on the treatment of typhoid fever 
published in the first volume of the Pennsylvania 



196 SELECTED ADDRESSES 

Hospital Reports in 1868, in which he showed that 
his judgment was not warped by his fondness for 
morbid anatomy and that he could discern the differ- 
ence between an essential and a secondary morbid 
lesion. 

It is interesting to recall that he himself suffered 
a severe attack of typhoid fever in 1837 and soon 
after this another attack of serious illness, from which 
he never entirely recovered, retaining a slight loss of 
power in the lower extremity of one side. In the fail 
of 1868, after a short trip to Europe, he suffered a 
fracture of the leg, from which he almost died, but 
lived six years longer. 

It seems not inappropriate that these portraits of 
Dr. William W. Gerhard and William Hunt should 
be unveiled in this season of unveiling of statues of 
distinguished men more or less identified with the 
history of Philadelphia, first, of Washington, on May 
14th; again, of Stephen Girard, on May 21st, during 
the semi-centennial anniversary of the founding of 
the American Medical Association. 



XII 

RESPONSE TO THE TOAST OF OUR "FOR 
EIGN GUESTS" AT THE ANNUAL DIN- 
NER OF THE BRITISH MEDICAL 
ASSOCIATION AT ITS MEETING 
IN PORTSMOUTH, ENGLAND, 
AUGUST, 1899 



XII 

RESPONSE TO THE TOAST OF OUR "FOR- 
EIGN GUESTS" AT THE ANNUAL 
DINNER OF THE BRITISH MEDICAL 
ASSOCIATION, AT ITS MEETING AT 
PORTSMOUTH, ENGLAND, AUGUST, 
1899. 

I need not say that I feel honored in being asked to 
respond to the toast of "Our Foreign Guests," regard- 
ing as I do the British Medical Association- as the 
typical representative medical association of the world, 
distinguished alike for its eminent membership and 
high aims. 

For many years I have read wistfully the announce- 
ments of the annual meetings, looking for the op- 
portunity which has come to me only this year; for 
although present at the meeting at Montreal in 1897, 
it did not seem so much the real event as this does. 
I regret that some one could not be found better fitted 
by experience and ability to reply to such an important 
toast. Especially do I feel my shortcomings when 
I recall the able address of your president, Dr. Cousins, 
and the appropriate and trenchant remarks of the 
mover and seconder of the resolution of thanks to him. 
But I can at least express to you in my own way in 
behalf of the foreign guests, thanks for your cordial 
reception and the opportunities given us to share with 
you the proceedings of the association and the pleas- 
ures derived from the hospitality of this ancient and 
honorable city and from the numerous objects of 
interest in which it abounds. 

One thought has come to me of which I have had a 
growing realization of late years, and which I would 
like to leave with you. It is the important influence 

199 



200 SELECTED ADDRESSES 

which science, and, as a part of it, medicine, through 
such meetings as this may exert in diffusing a senti- 
ment of good will and amity throughout the civilized 
world. In illustration of what I mean I may recall 
an incident reported in connection with the late 
Spanish- American War. About the time of the begin- 
ning of active hostilities and when the intensest feeling 
prevailed, there was sitting in Madrid a scientific 
congress, I think, of Hygiene, at which an American 
delegate was present. Instead of the angry feeling 
which might reasonable have been expected, being 
shown him, the utmost courtesy and consideration 
were substituted. I believe that scarcely under any 
other circumstances could this have occurred. 

While foreign ministers and consuls were receiv- 
ing their passports and retreating not without risk 
to their lives, this unpretending scientist was sacredly 
guarded by his confreres from insult and injury. This 
I believe to be no exceptional conduct, but rather the 
rule among scientific men, and the direct result of the 
leaven of science, under the influence of which un- 
seemly national bickerings and misunderstandings I 
trust will soon become events of the past. We may 
not quite agree as to the efficiency of Salicylate of 
Sodium in gout, but there is no difference of opinion 
as to the proper conduct of man to man. Science and 
commerce it appears to me are to be the agencies 
above all the others through which will be consum- 
mated the harmony of nations for which we Anglo- 
Saxons are fondly looking — the time 

"When nations like brothers will embrace, 
"That war be banished from the thoughts of men, 
"And ignorance with all its evils cease." 

Diplomacy is suspecting, but science is ingenuous 
and the very foundation of commerce is confidence. 



ADDRESS AT PORTSMOUTH, ENGLAND 201 

To the members of a profession in one country 
nothing is likely to be more interesting than the con- 
dition of the same profession in another, and it may 
interest you somewhat to have me say a few words as 
to the profession of medicine in America, its present 
status and possible future. I believe the profession 
in Europe has been in the habit of regarding that in 
America as less highly educated and not so well trained 
as that in the home countries. This I think must be 
acknowledged to have been the case in the past, 
while it was still not incompatible even at an early 
date with the evolution of some highly accomplished 
physicians and surgeons in America, as attested by 
the names of Warren and Bowditch in Boston; of 
Flint and Clarke in New York, of Physick, Wood, 
Pepper, Gross, Agnew, Stilly Mitchell and DaCosta 
in Philadelphia. 1 Of late years a most encouraging 
change has I taken place. The preliminary examina- 
tions have been gradually broadened so that in some 
of our Medical Schools the degree of Bachelor of Arts 
is required or an examination equivalent, while in 
almost all colleges the requirements are now on a re- 
spectable plane. Our courses either have been pro- 
longed to four years or will be within three years. 
Our best schools are departments of universities. Our 
students walk the wards of the hospitals and are 
brought into personal contact with disease and our 
examinations are more rigid and exacting. A certain 
number of our profession have always been drawn 
from the best people socially, and in no country per- 
haps, as much as in America has the physician as 
high a social position if his education and manners 
justify it. It is very usual to have many generations 

1 The men eminent in the earliest history of the profession in 
America, such as Morgan and Shippen, are not mentioned, because 
they were mostly educated abroad. 



202 SELECTED ADDRESSES 

of families represented in the medical profession. For 
our Army and Navy Medical Service the utmost care 
has always been exercised as to the personnel and pro- 
fessional qualifications of its members. And it has 
more than once happened that a gallant and efficient 
officer of the line has been drawn from the medical 
staff. Even our far western country, where the in- 
ducements to the practice of medicine on account of 
hardship and meagre compensation are not great, is 
being gradually supplied with educated physicians 
from the eastern schools. In fact I do not see much 
difference between the best type of American physician 
and the English physician of a corresponding date. 

What has struck me in attending this association 
more than anything else is the greater average age of 
those in attendance and active in its proceedings. 
Among us, at a meeting of the American Medical 
Association, for example, the proceedings would be 
in the hands of a younger set. And this is perhaps 
what we might expect and what shows the real differ- 
ence in the professions in the two countries. In 
America a much smaller number of the older men will 
have had the advantages of the better education and 
training. In another twenty-five years this will be 
altered, and we will become more and more alike. A 
oneness of language and nearly a oneness of race, with 
a similarity of educational methods will tend more and 
more to this, and I for one shall rejoice. I feel that 
we are really one people with like aims and like des- 
tinies. No one can appreciate this better than an 
American who has gone from his own country to the 
continent, and after a short time spent there battling 
with German and French and Norwegian, comes to 
England, where all is changed, simplified and life is 
once more easy and practicable. You English only 
want to do one thing more to become very good 



ADDRESS AT PORTSMOUTH, ENGLAND 203 

Americans, and that is to change your pounds, shillings 
and pence into a decimal system and both English 
speaking nations should change our pounds, ounces 
and pennyweights into kilos and meters. 

In conclusion again I thank you for the courtesies 
extended to the foreign guests. 



XIII 
A PHYSICIAN'S HOLIDAY AT KAELSBAD 



XIII 
A PHYSICIAN'S HOLIDAY AT KARLSBAD x 

To the American seeking Karlsbad, by far the most 
convenient route is by steamer to Hamburg and thence 
by rail via Berlin and Dresden, arriving in 18 hours by 
day or night train. A break in the journey may be 
made at either of the last named places. Northern 
Germany is somewhat flat and monotonous, but to 
one who travels if for the first time it is still sufficiently 
novel to make a day trip enjoyable. Dresden once 
passed, the scenery becomes more varied and attrac- 
tive. First is traversed the valley of the Elbe, swiftly 
flowing between high and sometimes rugged hills, then 
the valley of the Eger to its junction with the Tepel on 
both sides of which Karlsbad is built. Some minutes 
before arriving at our destination its nearness is pro- 
claimed by a fine view of the Stephanie Tower, erected 
on the summit of one of the many adjacent hills to 
commemorate a visit of the Princess Stephanie. In- 
significant as appears the little river Tepel, to the 
visitor in the season, on more than one occasion 
freshets have washed away its bridges, while the town 
itself has suffered destructive inundations. So narrow 
is the valley in places that there is room for but a 
single row of houses and shops on each side. Much of 
the town is built in terrace-like arrangement on the 
mountain sides. It has grown rapidly of late years 
and accommodates now 15,000 permanent residents 
and 50,000 patients annually, exclusive of visitors and 
tourists. Itself over 1200 feet above the level of the 

1 Reprinted from The Philadelphia Medical Journal, January 
5, 1901. 

207 



208 SELECTED ADDRESSES 

Adriatic Sea, the town is further surrounded by the 
Karlsbad Hills, which rise from 200 to 800 feet higher. 
As the stream is ascended the hills separate to form a 
wide, luxuriant meadowed valley. This valley opens 
to the north, which explains the lower and changing 
temperature that characterizes it as contrasted with 
the adjacent country, and necessitates at all seasons 
a judicious selection of clothing. The hills are also 
covered with a dense growth of fir, pine, oak, and 
beech, which by their various shades of green add a 
further charm to the beautiful scenery. The hills are 
traversed by miles and miles of paths of easy grade 
provided and scrupulously cared for by the authorities 
for the pleasure and benefit of the patients. 

It is at first a disappointment to the visitor to find 
that the springs are not in the center of beautiful parks, 
as is the case at so many of the European spas, but 
are in the heart of the town. In this respect it is more 
like Aix-la-Chapelle. The springs are, however, sur- 
rounded by imposing colonnades and halls erected for 
the convenience of visitors, while the missing park is 
more than compensated for by the walks referred to, 
almost every one of which leads to a picturesquely 
situated cafe, offering tempting refreshment to the 
pedestrian, and commonly presenting an extended 
view of the surrounding country. 

The several springs which constitute the Karlsbad 
Spa do not differ essentially in the composition of 
their waters, the chief difference being in the tempera- 
ture at which they emerge from the earth. Sodium 
sulfate, sodium carbonate, and sodium chlorid are 
the principal constituents of each, and are found in 
astonishingly close proportions in the different springs, 
as seen in the appended table: 

Thus the springs are of the alkaline saline class, 
containing also considerable carbonic acid. The tern- 



PHYSICIAN'S HOLIDAY AT KARLSBAD 209 

perature of the different waters as they are discharged 

is as follows: 

Deg. R. Deg. C. Deg. F. 

Sprudel 58.0 72.5 162.5 

Franz Josephs Quelle 51.0 63.7 146.7 

Bernhardsbrunn 48.5 60.7 141.2 

Felsenqelle 47.8 59.7 139.5 

Neubrunn 47.2 59.0 138.2 

Theresienbrunn 46.2 57.7 135.8 

Schlossbrunn 39.2 49.0 120.2 

Kaiserbrunn 38.8 48.5 119.3 

Muehlbrunn 38.4 48.0 118.4 

Russische Krone 36.4 45.5 113.9 

Marktbrunn 32.8 41.0 105.8 

Elisabethquelle 32.5 40.7 105.2 

Parkquelle 32.2 40.2 104.4 

Kaiser Karl Quelle 31.5 39.4 102.9 

Kochberger Quelle 31.5 39.4 102.9 

Spitalbrunnen 28.2 35.2 95.3 

It will be seen that the water from the Sprudel 
Spring is the warmest, being 162.5° F. It is also 
spoken of as the " strongest," but it is evident that any- 
increased activity cannot be due to increased propor- 
tion of constituents. It is probably due to the higher 
temperature, which favors its more rapid absorption 
and greater activity. It is certainly the most interest- 
ing to the casual visitor. Often totally obscured by 
the steam which arises in dense clouds above and 
around it, it suggests a huge boiling caldron. From 
its center spout columns of hot water which scatter the 
spray so widely that the water must be dipped up with 
cups at the end of long poles, while the girls serving it 
are protected with waterproof coats and jaunty rubber 
caps. 

All the springs belong to the municipality of Karls- 
bad, and immense sums of money have been spent 
from time to time in constructing handsome colon- 
nades and sumptuous bathhouses about them. Of 
the former, the finest is the Muhlbrunn Colonnade, 

14 



210 SELECTED ADDRESSES 

erected at a cost of $320,000, competing in architec- 
tural beauty with any similar structure in the world. 
The Sprudel Pavilion, built over the Sprudel and Hy- 
geia Springs, is a large and handsome hall constructed 
of glass and iron. In connection with it are also 
bathhouses. The bathing establishments are the 
"Kurhaus," with mineral water baths, mud baths, 
douches, common water baths, and carbonated water 
baths; the "Neubad," with Sprudel water baths and 
mud baths; and latest of all, the costly "Kaiserbad," 
completed in 1895 at a cost of nearly half a million 
dollars. It contains thermal and common water 
baths, cold douche and shower baths, mud baths, elec- 
tric baths, and electric-light baths, with a complete 
Zander's establishment for Swedish hygienic gymnas- 
tics and massage. These fine modern buildings, some 
of which contain also offices and reading-rooms, were 
constructed in rapid succession since 1875 to meet 
the growing demand of annually increasing visitors, 
taking the place of older and more imperfect 
structures. 

Why patients go to Karlsbad. — It is creditable to the 
physicians and others interested in Karlsbad, that they 
do not claim that the "Cure," as it is called, is appli- 
cable to all diseases. On the other hand, they publish 
a long list of which the contrary is stated. Thus it is 
contraindicated in inflammatory and febrile affec- 
tions, in bronchitis and tuberculosis of the lungs, in 
secondary and tertiary syphilis, in carcinoma and the 
various degenerations, in diseases of the heart and 
bloodvessels, especially atheroma and aneurysm, in 
pregnancy, in advanced Bright's disease, in the debil- 
ity of old age, or where there is decided weakness from 
any cause; nor, so far as I know, is any efficiency 
claimed for these waters in the treatment of diseases 



PHYSICIAN'S HOLIDAY AT KARLSBAD 21 1 

of the nervous system. Cirrhosis of the liver is also 
an affection for which no benefit is claimed. 

Before taking up the diseases for which the treat- 
ment is beneficial, let us consider first the effect of 
the waters, and in what the treatment consists. As to 
whether they are palatable or not, is largely a matter of 
individual taste. To me both warm and cold waters 
were agreeable, and to the majority they are not un- 
pleasant. Yet, during my visit, I met one of my Phila- 
delphia medical friends who told me that the Sprudel 
water so nauseated him that he was unable to take 
it. This I believe to be unusual. When drunk they 
come first, of course, in contact with the mucous mem- 
brane of the stomach and bowels, and are said to be 
soothing to these surfaces, allaying pain and arresting 
spasm. These effects may be produced by neutral- 
izing unnatural acidity, I see not how else. After 
absorption, their alkaline constituents increase the 
alkalinity of the blood, promote its solvent power and 
its mobility. Thus is counteracted any tendency to 
stagnation, especially in the portal circulation. This 
effect is further favored by the purgation which is 
induced in a few days, if not immediately after their 
use is commenced. Such facility of circulation also 
relieves the lymphatic vessels, and it is thought favors 
molecular change and the absorption of subcutane- 
ous fat and inflammatory products. By the purgative 
effect, too, the bowels are flushed and cleared of mucus 
and accumulated feces, while normal secretion is thus 
stimulated. The effect of the waters is increased when 
drunk on an empty stomach, when absorption is most 
rapid. The hotter waters are taken when more ener- 
getic action is desired, the cooler when a less positive 
effect is sought. The greater activity of the hotter 
waters is ascribed, as already stated, to their more 
rapid absorption. The quantity advised varies from 



212 SELECTED ADDRESSES 

two to six cups a day — 10 to 30 ounces — and is deter- 
mined by the physician who is consulted. So far as 
I could ascertain, the larger quantities are rarely 
ordered. Several minutes should be occupied in the 
drinking, and from 10 to 15 minutes allowed " between 
cups." The promenade, the music of the orchestras 
which play from 6 to 8 at the more popular springs — 
the Muhlbrunn and the Sprudel — the novel surround- 
ings which include especially peculiarities of appear- 
ance and dress characteristic of different nationalities, 
all contribute to make the time pass pleasantly and 
rapidly. 

But the drinking of the waters is by no means all of 
the Karlsbad treatment, and it is conceded by the most 
enthusiastic of its supporters that if limited to this 
only, the treatment would be far less efficient, as well 
as less picturesque and pleasurable. The visit to the 
springs is early, between 6 and 8. Perhaps the largest 
number is found about 7 o'clock. After the allotted 
number of glasses have been drunk the patient proceeds 
to one of the numerous bakeries and buys the bread 
for his breakfast, bread the most delicious to be found. 
It may be a prescribed quantity in the shape of rolls, 
or crescents, or zwieback, or the quantity and variety 
may be limited only by the appetite and taste. Then 
he proceeds to the meat shop, where he buys his ten to 
twenty kreutzers worth of tempting cold boiled ham. 
The pink and white paper packages containing these 
are carried to one of the numerous cafes from half a 
mile to two miles distant. A table is selected always 
in the open air, if weather and season permit, whence, 
too, there is commonly a pretty outlook towards the 
rich green meadows and hillsides. By this time our 
patient is quite hungry and welcomes one of the neatly 
dressed waitresses who comes with a cheerful "Guten 
Morgen," for his order for eggs and coffee. The coffee 



PHYSICIAN'S HOLIDAY AT KARLSBAD 213 

is scarcely less excellent than the bread, and he is soon 
busy in the pleasurable occupation of breakfasting. 
So far as my observation went, this breakfast is not 
at all limited as to quantity, and the delightful sur- 
rounding and abundant leisure do not dispose one to 
eat less than he desires. 

Breakfast over, there is more walking. It may be 
for a short distance or for miles on the many pleasant 
paths already described, where abundant resting places 
are provided until noon is near — the hour at which the 
baths are usually taken, although many are prescribed 
for early morning hours. For it is only on the physi- 
cian's prescription as to kind, duration and temperature 
that the baths are allowed, unless the visitor happens 
to be "selbst ein Artzt," when not only is he permitted 
to select his own baths, but also becomes the guest of 
the town, receiving a card which admits him to the 
baths free of cost, except, of course, the douceur to the 
attendant. In common with all others who remain 
more than a week, he must pay the music tax, which is 
collected by a polite official who comes direct to his 
rooms without ceremony. The tax is five florins, or 
$2.00, for the ordinary well-to-do visitor who is termed 
a person of the " first class/' eight florins, $3.20, for a 
party of two persons, with a further reduction per 
capita for parties of large numbers. 

The bath completed, dinner follows shortly. For 
this the neighborhood of one o'clock is advised, the late 
dinner hour being discouraged by the physicians. The 
dinner may also be more or less prescribed by the phy- 
sician whom the patient has consulted, but here again, 
there is much erroneous conception as to what con- 
stitutes the Karlsbad diet, doubtless because years ago 
greater stringency was insisted upon than at present. 
At the present day at least the rigid dietary rules 
which if neglected are followed by severe punishment 



214 SELECTED ADDRESSES 

are a myth. For the patient under treatment the 
food is simple but sufficient. It may include soup, fish 
except salmon, beef, mutton, poultry, game without 
rich dressings, green vegetables, including peas, beans, 
spinach, cauliflower and the like. Spices and stimulat- 
ing condiments, such as pepper and mustard, are pro- 
hibited. Soup is often disallowed because it occasions 
distention. Nor is wine always prohibited. In fact, 
it is sometimes ordered by the physician, especially the 
light wines of the country, which are good and inex- 
pensive. So, too, the delicious Munchener or Pilsen 
beer is sometimes allowed and even prescribed. On the 
other hand, champagnes and heavy wines are rightly 
prohibited. The town water of Karlsbad is pure and 
wholesome, though it is quite usual to drink some one 
of the "sauerbrunn," or natural carbonated waters, in 
which the vicinity abounds, especially the Gieshiibler 
and Biliner which are also used in admixture with 
wines. On the other hand, waters highly charged with 
carbonic acid such as Apollinaris are discouraged be- 
cause they are thought to distend the stomach by 
liberated gases. Dinner over, a short stroll followed 
after a brief rest by a longer walk or a drive may be 
taken. At four o'clock the music again invites to the 
garden's and cafe's air. Supper, especially, should 
be kept within bounds. Tea, bread and butter, an 
omelet and a little stewed fruit constitute if for the 
most part. In the evening for those who desire it is 
the opera in one of the most attractive little opera 
houses on the Continent, and at some of the larger 
hotels, like Pupp's, there is music, but by 10 o'clock 
most persons are in bed or at home, so that a marvelous 
quiet settles down on the town. Indeed nothing so 
much impressed as the absolute stillness which per- 
vaded the town soon after 10 o'clock. Streets which 
during the entire day, and especially in the early morn- 



PHYSICIAN'S HOLIDAY AT KARLSBAD 215 

ing and early evening, are filled with pedestrians are 
deserted and " early to bed" is as invariable as " early 
to rise" for which it is also a preparation. On the 
whole, the life at Karlsbad is an ideal one, with just 
sufficient amusement, exercise, and treatment to oc- 
cupy the time pleasantly, so that it is not surprising 
that persons return year after year for the pleasure as 
well as the health-giving advantages afforded. 

As to the diseases for the treatment of which Karls- 
bad is famous, gout and its complications are foremost. 
The rationale of the effect can only be inferred, but it 
appears reasonable to believe that the action of the 
waters is, in the first place, depurative and neutralizing 
on the materies morbi, be it retained uric acid or some- 
thing else — depurative by their aperient action, and 
neutralizing through the increased alkalinity of the 
blood resulting from their absorption. Second, the 
baths further increase elimination, and in conjunction 
with massage, tend to remove the local swellings and 
stiffness of joints which are responsible for so much dis- 
comfort in gout. Third, the vigorous exercise which 
forms an important part of the treatment still further 
increases elimination and contributes to the removal 
of the conditions referred to. Fourth, the restricted 
diet, from which proteids and wines are excluded or 
reduced to a minimum, keeps out substances which go 
to make up the toxic product causing the disease. It 
is probably the combined action of these agencies 
which is responsible for the beneficial effect of the 
Karlsbad treatment on the symptoms of gout. It is 
said in some instances the pains of gout are increased 
by the first effect of the waters which dissolve out the 
uric acid from other situations and carry it to other 
vulnerable points, whence it is ultimately washed out. 
It is more than likely that the beneficial effect of the 
treatment on gout would be prolonged after the patient 



216 SELECTED ADDRESSES 

returns to his home if the same line — hygienic and 
dietetic — were kept up. It is not only the appetite 
and careless eating and drinking that are responsible 
for the retrogression, but also the trouble and difficulty 
of carrying out at home other parts of the treatment, 
which cause it to be gradually relaxed and followed by 
relapses which make recurring visits necessary. To be 
surrounded by social and business demands at home is 
very different from being one thousand or more miles 
away with nothing to do but to carry out a treatment 
for which expressly the journey is made. 

All that has been said of gout is equally true of the 
tendency to uric-acid deposits and gravel, the solution 
of these being favored by the alkalinity of the blood 
and secretions. 

The more usual forms of rheumatism of other than 
gouty origin, articular and muscular, are also success- 
fully treated at Karlsbad by massage, exercise, the 
thermal baths, and especially the peat baths, which 
are a unique experience. Unpleasant as is at first the 
idea of submerging one's self in a mass of thick hot 
mud, yet the first unpleasantness overcome, the 
experience becomes a pleasant one. The usual notion 
of mud as something purely filthy is soon dispelled, 
while there is a fragrance about the organic matter of 
the peat which is agreeable. It is brought from some 
distance in the vicinity of Marienbad where the Karls- 
bad authorities own a tract of peat land. The peat 
is ground to a required degree of fineness and then 
mixed with the hot Sprudel water. The bath is taken 
commonly at a temperature of about 28° Reaumur, 
or 95° Fahrenheit. Massage forms an important 
part of the treatment of rheumatism. 

While upon the subject of baths I may as well de- 
scribe the two remaining baths which seem worth 
special allusion. They are the electric water bath, 



PHYSICIAN'S HOLIDAY AT KARLSBAD 217 

the electric-light bath and the carbonic-acid water 
bath. In the electric water bath the patient is im- 
mersed in the ordinary tub bath at a temperature of 
about 95° F., and becomes a part of the electric circuit. 
With sufficient strength a tingling burning sensation 
over the entire surface of the body which with stronger 
currents becomes even painful. In a short time the 
skin becomes decidedly reddened. I do not know 
that any settled explanations of the operation of the 
electric water bath is proposed by those who employ 
it honestly for other than the mental effect. As stated 
the only evident effect is on the skin. It is undoubt- 
edly countei irritating to the skin. Through this 
nutrition may be influenced first in the skin itself and 
second upon the muscular and nervous tissues below 
it. I think it not unlikely that this form of bath may 
act as a cardiac stimulus similar to that of the Nau- 
heim bath. 

The electric-light bath is an interesting bath. It 
consists of a cabinet in which the patient is enclosed, 
except his head. Numerous electric lights project 
from the sides of the cabinet towards its interior. The 
bath is a sweat bath in which the heat is derived from 
the electric lights, and of which the chief feature is 
that the sweating takes place at a much lower tem- 
perature than in a vapor or hot air-bath. My recollec- 
tion is that it is about 95° F. None of the physicians 
with whom I conversed at the Kaiserbad were able to 
offer any explanations. 

For the carbonic-acid bath, the sprudel spring 
water is charged with caibonic acid under pressure, 
and the baths seemed to me almost identical with the 
baths at Nauheim which I also visited. The little 
bubbles of carbonic acid collect in immense numbers 
on the skin precisely as in the Nauheim baths, and as 
the water is also a strong saline solution, the same 



218 SELECTED ADDRESSES 

effect of cardiac stimulation may be reasonably 
expected. 

Next after gout — if not before — come portal con- 
gestions and gastrointestinal catarrhs. They are in- 
fluenced through the depurative action of the waters, 
the bathing, massage, exercise, and restricted diet. 
Careful adjustment of diet is most important in these 
affections and the local physicians look closely to this, 
and with the happiest results. 

Gallstones and hepatic colic are among affections 
for which much is claimed by the Karlsbad physicians, 
and apparently with reason. It is hald that the ex- 
pulsion of stones is facilitated, sometimes painlessly, 
but more frequently with the colicky pain usually 
associated with such expulsion after the thermal 
treatment. This seems to be generally conceded. 
An incontrovertible explanation has not been offered. 
The most likely is that the results depend upon a 
flushing of the gall-ducts by a thin bile and the free 
purgation which drains especially the duodenal end 
of the bowel. Another very interesting consequence 
of the reputation Karlsbad possesses in this respect 
is the aggregation of a large number of cases of gall- 
stone impactions, which failing of relief by the effect 
of the waters come to the surgeon's hands. As 
a consequence many cases are received into the local 
hospital by the local surgeon, who has had remark- 
able success. 

Diabetes is another one of the ills for which Karlsbad 
is resorted to by large numbers. It has seemed to 
me that the effects are among the least satisfactory 
of any claimed. This conclusion is not based on ob- 
servation while at Karlsbad, for I was there too short 
a time to justify any conclusions. But it has hap- 
pened to me to send a great many diabetics to Karls- 
bad, and while many have been benefited, these have 



PHYSICIAN'S HOLIDAY AT KARLSBAD 219 

always been the milder cases, while the improvement 
has not seemed more permanent than which always 
took place when they first came under treatment at 
home and abroad, and especially abroad where the 
cooperation of other favorable influences is brought to 
bear. Indeed, the most claimed by Karlsbad phy- 
sicians with whom I have discussed the matter, seemed 
to be as follows: In cases coming to Karlsbad where 
the best that could be done at home was to reduce the 
percentage of sugar to a fraction of 1 %, the result of 
treatment at the Spa is to take the sugar out altogether. 
In cases where the home treatment removed a portion 
of the sugar, but left a considerable percentage, the 
Karlsbad treatment reduced the percentage of glucose, 
but could not eliminate it altogether. This increment 
of effect may be the direct effect of the water drunk, 
probably through its alkalinity. An experiment by 
Salkowski, to which my attention was called by Dr. 
Edgar Gans, at Karlsbad, tends to confirm this proba- 
bility. He noted first that the artificial digestion of 
starch by pancreatic extract was delayed by the addi- 
tion of saccharine, and second that this inhibitory 
effect was counteracted by the addition of sodium 
bicarbonate and the digestion proceeded. On the 
other hand, the dietetic treatment is no less rigid than 
at home, commonly more so, and more strictly carried 
out, while the cheerful surroundings have their due 
influence. There can be no doubt, therefore, that to 
the diabetic who is not too far advanced in the disease 
and who can afford a somewhat expensive journey, 
a trip to Karlsbad will be of service by diminishing 
or removing his symptoms, by invigorating and en- 
couraging him, giving him a fresh start as it were, 
whence the outlook is promising and hopeful. 

Obesity is one of the recognized objects of the treat- 
ment. Indeed, I never before saw so many fat men 



220 SELECTED ADDRESSES 

and women gathered in one place, though by no means 
every fat person who goes to Karlsbad goes there to be 
treated for obesity. The majority are altogether too 
deliberate in their actions, and they eat too much. 
The treatment for obesity is undoubtedly effective in 
reducing fat, but here as elsewhere the effect is only 
accomplished by hard work. The following experi- 
ence related by the late Professor Horatio R. Bigelow 
in his interesting paper on Karlsbad, published 13 
years ago, may be considered a sample. He says: 
"When I came to Karlsbad, I weighed between 186 
and 190 pounds (American). As I am only 5 feet 
6| inches tall, this was too portly, even for a London 
alderman. Dr. Grimberger advised the Kur. I be- 
gan with 2 glasses (March 16) of Marktbrunn daily, 
to which was added on March 20, 1 glass ofMuhl- 
brunn. This was never increased during the 8 weeks 
of my cure. The water was sipped gradually; then, 
after an interval of 15 minutes, the second glass was 
taken, and so the third. After that a walk of from 
1 to 2 hours and then breakfast. A cup of tea or 
coffee (with milk and sugar), 2 rusks and 2 soft-boiled 
eggs, then a climb of 2 or 3 hours, and home to dinner — 
a piece of rare meat and one vegetable with an occa- 
sional glass of Hungarian wine. Then another long 
walk, followed by a supper at 7, consisting of tea, rusks, 
and cold meat. I took a few warm and vapor baths, 
especially when in Berlin, where I was called upon 
business, being absent about 10 days. While away I 
kept up my diet rules most strictly, but not being able 
to exercise as vigorously, I indulged somewhat in 
Turkish baths. Latterly, I have given up coffee 
and take no milk in my tea. At first the waters caused 
a natural but rather active movement from the bowels; 
then, for 2 or 3 weeks the discharges were more fre- 



PHYSICIAN'S HOLIDAY AT KARLSBAD 221 

quent (twice, and sometimes 3 times per day), and 
then came an interval of constipation. 

"I weigh now (May 26) about 155 pounds with 
winter flannels. My weight, naked, at the Kur Haus 
bath rooms was, on May 23, 87 kilograms — 148 Ameri- 
can pounds. I exercise 3 or 4 hours daily, and observe 
a vigorous self denial in matters of diet. It will be 
seen that from March 4 to March 10 I lost nearly a 
pound per diem, but during this time I am sure that 
I walked between 24 and 25 miles daily. At no time 
have I felt unpleasantly." He says, moreover, "the 
share of the waters in this role must be considered a 
small one." 

Be this as it may, I am confident that the benefits of 
the Karlsbad treatment are very great to fat persons, 
even if it does not reduce their fat, or reduces it 
moderately, as is more often the case. It is the fat 
person whose circulation is sluggish, whose bile is 
thick, whose gallbladder is full of faceted stones, with 
or without biliary colic. All of these conditions are 
benefited by the "cure." 

The Karlsbad waters are claimed to be efficient in 
certain diseases of the skin. Erysipelas migrans, 
sclerosis of the skin, urticaria, pemphigus, and eczema 
in their milder forms, and furunculosis are mentioned. 
I did not have an opportunity to see any of these 
affections under treatment while at Karlsbad, but I 
have seen a most obstinate case of urticaria which re- 
sisted all other treatment at home, greatly relieved 
by full doses of the Karlsbad Sprudel salt, dissolved 
in hot water. At the end of 1 week's treatment a life 
of comparative comfort was substituted for one of 
misery. 

A most important and comparatively recent appli- 
cation of the Karlsbad mineral waters has yet to be 
described. It is that of Dr. J. Mtiller, an accomplished 



222 SELECTED ADDRESSES 

specialist in nose, ear and throat affections. He avails 
himself of the hot Sprudel water in spraying the nose 
and throat with powerful sprays produced by the pres- 
sure of expanding compressed carbonic-acid gas. By 
substituting carbonic-acid pressure for atmospheric 
air pressure he reduces the pressure from 7 atmospheres 
to 1| atmospheres. The spray is allowed to pass for 
10 to 15 minutes into each nostril and 10 to 15 minutes 
into the throat. In this way a most effectual irrigation 
of these parts is secured as compared with which the 
ordinary nasal spray is as mist compared with rain. 
This treatment is applied for nose, throat and laryn- 
geal affections, and I have reasons to believe that it 
is efficient. When in Vienna, where Dr. Muller 
practises in winter, he uses the Karlsbad Sprudel salt 
dissolved in hot water. 

No description of Karlsbad and its treatment at this 
day should omit an allusion to the finely appointed 
Zander establishment for Swedish hygienic gymnastics 
and massage at the new "Kaiserbad" under the direc- 
tion of the accomplished Dr. D. Tyrnauer. This 
probably surpasses all similar institutions of the kind, 
being the newest and latest. It is very interesting 
to watch the patients passing from one machine to 
another, and securing thus every conceivable variety 
of gymnastic exercise, everything working smoothly 
and spiritedly. I will conclude this paper by quoting 
without comment the purposes of the treatment. 

1. To prevent the injurious consequences of a 
sedentary mode of living or of one sided muscular 
action. 

2. Ailments and disorders of the organs of move- 
ment, as : sprains, stiffness and weakness after fractures 
of bones and other injuries, crookedness of the limbs 
and of the vertebral column. 

3. Dilatations of the stomach and bowels, chronic 



PHYSICIAN'S HOLIDAY AT KARLSBAD 223 

constipation, enlargement of the liver, hemorrhoids, 
neuralgia (sciatica), writer's cramp and similar affec- 
tions, chorea, cases of paralysis and weakness of 
various kinds. 

4. Obstructions to the circulation of the blood, dis- 
eases of the heart and their attendant consequences, 
overaction of the heart, weakness of the heart, begin- 
ning fatty degeneration of the heart, changes in the 
bloodvessels from old age, nervous heart complaints. 

5. Diabetes mellitus, uric-acid diathesis, gout, adi- 
posity and chronic metal-poisoning. 

"In all these cases, says the published statement/ ' 
a combination of the Karlsbad course of baths and 
waters with the mechanical treatment will be in the 
highest degree successful." 

The Most Suitable Time for Visiting. — Karlsbad 
may be visited at any time, but what is known as 
"the season" begins with the fifteenth of April and 
extends to the first of October. The most popular 
months are June and July, and during these two 
months the wealthiest and most fashionable visitors 
are found, while the rates for rooms are higher. Au- 
gust is also a popular month, but towards the end of 
it there is quite a decided falling off in the number of 
patients and visitors. To a person having full con- 
trol of his time, I should say complete your "Cure" 
by the middle of August, for although there are many 
lovely days after this date, the mornings and evenings 
become cool and the latter damp, especially in the 
deeper and narrower parts of the valley where the air 
cannot change rapidly and thoroughly, and persons 
subject to catarrhal troubles are apt to take cold. 
Moreover, although Karlsbad is an exceptionally 
salubrious city, in which no epidemic has ever pre- 
vailed, it is reasonable to suppose that the coming 
and going of 50,000 visitors must have an effect 



224 SELECTED ADDRESSES 

towards the end of the season in contaminating the 
purity of the air and drainage, while occasionally a 
case of typhoid fever does crop out towards the end 
of the season. 



XIV 
A PHYSICIAN'S HOLIDAY AT VICHY 



IS 



XIV 
A PHYSICIAN'S HOLIDAY AT VICHY 1 

The distance from Paris to Vichy is accomplished by 
express trains in an uneventful journey of six hours, 
but the two days occupied in covering the same dis- 
tance by automobile is a pleasant memory, including 
many noteworthy features invisible from the railway 
train, with lodgings and lunchings in out-of-the-way 
places, possible otherwise only to the traveler by car- 
riage; while the tedium of the latter is replaced by 
the exhilaration of more rapid motion in the open air, 
over roads that are marvels of smoothness and a 
country like a garden in the thorougness of its cultiva- 
tion. The approach to Vichy is not, however, impres- 
sive, as the town is neither prominently situated nor 
approached from a commanding point. But as our 
vehicle winds its way through streets crowded with 
pedestrians and lined with villas, hotels and shaded 
parks, interest is quickened and anticipation raised. 

More precisely, Vichy lies on a moderately elevated 
plateau, about nine hundred feet above the sea, on the 
right bank of the river Allier, in the department of 
the same name, about 225 miles southeast from Paris. 
It has a permanent population of 12,000, with over 
80,000 annual visitors. 2 While less picturesquely 
situated than some of the spas on the mountain sides 
and in the valleys, it is correspondingly less damp, and 

1 Reprinted from The Philadelphia Medical Journal, February 
14, 1903. 
2 1903. 

227 



228 SELECTED ADDRESSES 

there are more clear days. The heat of summer is 
tempered by storms which come down from the neigh- 
boring Auvergne Mountains. Outside the healing 
virtues of its waters the attractions are artificial rather 
than natural, but no expense has been spared by the 
Vichy Company to make them all that can be desired. 
The handsome parks, the old and the new, the latter 
extensive and bounded by the river, afford pleasing 
promenades, while longer walks are available by good 
paths to interesting places in the vicinity, notably 
Cusset with quaint old streets and houses, also the seat 
of several springs; Busset with its interesting Chateau ; 
La Montagne Verte with fine view of the peaks of the 
Auvergnes; Hauterive, one of the most important 
springs; Chateau Billy with interesting ruins, and 
others more distant. The crowning place of amuse- 
ment is a beautiful casino and theater, just remodeled 
and provided with every convenience and comfort 
calculated to amuse and divert. In addition to opera, 
theater and concert, usually in the afternoon and even- 
ing, there are halls and salons, reading and conver- 
sation rooms tastefully decorated and invitingly 
furnished. 

Though Vichy cannot boast of the long line of his- 
torical associations which add to the interest of Karls- 
bad, it is, nevertheless, an ancient town, appearing in 
Gallic and Roman history, being called by the Romans 
Vicus callidus. From the fondness of the Romans for 
baths it may be expected that they availed themselves 
to the utmost of Nature's gifts, though no traces of 
Roman baths remain. It was early the seat of an 
abbey founded about 390 A. D., by St. Martin, Arch- 
bishop of Tours. This with the town was sacked and 
destroyed by the Normans, A. D., 845. The sturdy 
Normans had, however, little appreciation of such 
luxuries as baths, and, though they rebuilt the city, 



PHYSICIAN'S HOLIDAY AT VICHY 229 

they did not revive its former splendor and seemingly 
ignored the waters. 

Authentic information as to use of the waters of 
Vichy dates only from the founding of the Convent of 
Celestins by Louis II de Bourbon in 141-1, when the 
baths were used by the Sisters for the treatment of the 
sick who sought their aid. Jean Banc, a physician of 
Moulins, referred to Vichy in his book entitled "Les 
Merveilles des Eaux Minerales," as did also the phy- 
sicians in ordinary to Louis XIV, Nicola de Nicolai, de 
Duclas and Claude Fouet. Vichy was, however, first 
brought prominently to notice by Madame de SeVign6, 
who took a cure there in 1676. The erection of the 
first modern bath establishment was undertaken in 
1785 by the Ladies Adelaide and Victoria, aunts of 
Louis XVI, but was interrupted by the French revolu- 
tion of 1789, and, although Napoleon I. ordered the 
work to go on, it was not until 1814 that the Duchess 
d'Angouleme laid the first stone of the Thermal 
Establishment, after the completion of which health 
seekers commenced to visit the place from every quar- 
ter. Napoleon III did much to increase the popular- 
ity of Vichy, improving the city and building a chalet 
for the Empress Eugenie, which is still shown, as, 
indeed, is that of Madame de Sevigne. 

The springs and Thermal Establishment are the 
property of the State, but are leased by the Compag- 
nie Fermiere de FEtablissement Thermal de Vichy, or 
Vichy Company, as it is briefly called, by which all 
improvements are made. The bathing house was 
completed in 1820 and further enlarged in 1853. It 
is now an extensive establishment provided with 
baths which are designated first, second and third 
class, the last two being much less expensive, although 
the difference in the appointments is not great, and all 
the baths are scrupulously clean and inviting. This 



230 SELECTED ADDRESSES 

establishment, large as it is, is to be greatly surpassed 
by another new building, which, when finished, will 
doubtless be the most extensive and complete in the 
world. It will take the place of the baths of the first 
class, the site of which will be occupied by a promenade 
and drinking hall, covering the Grande-Grille, Chomel 
and Lady Springs, and an audience hall seating 1,300 
persons. At the date of my visit the erection was 
sufficiently complete to permit one to form a good idea 
of the extent and completeness of the new establishment 
which is under the direction of Dr. Lejeune. The part 
devoted to mechanotherapy, the Zander Institute, is 
now finished and in active operation under Dr. Ver- 
meulen, who informed me this treatment had already 
outgrown its new accommodations and the Institute 
would have to be enlarged. 

Like all similar places, Vichy is provided with nu- 
merous hotels and boarding-houses of every grade of 
appointment and expense, so that those in moderate 
circumstances as well as the rich may avail themselves 
of the cure. For drinking at the springs the waters are 
free to all, while the Company is required to allow a 
large number of free baths annually, so that even the 
very poor may share them. Vichy is, moreover, not 
nearly so expensive a place as one might suppose. 

As with Carlsbad so with Vichy, there are quite a 
number of springs in the town and vicinity, but like it 
also the waters present a composition remarkably 
uniform, but a temperature widely different at differ- 
ent springs. 

The chemical differences are minor, being largely in 
the amount of free carbonic acid gas. Of this the 
Lucas spring has the largest quantity, 1.751 gm. per 
liter, and the Chomel the smallest, 0.768; after the 
Lucas comes the Pare with 1.555 gm., FHopital with 
1.067 and Celestins with 1.049. The most abundant 



PHYSICIAN'S HOLIDAY AT VICHY 231 

constituent is sodium bicarbonate, about 5 gm. per liter, 
or 75 grains per quart, the Celestins leading with 
slightly more, while the Lucas contains one gram less 
to the liter. The total solids equal about 7 gm. per 
liter. Hauterive, the analysis of which is not included 
in the above, is similar in composition to the Celestins, 
cut contains rather more iron and sodium arsenate. 
Though the quantity of iron seems small, it is easily 
demonstrable by the addition of tannic acid. From 
some waters, as the Hauterive, the iron is precipitated 
from solution in transit. I had long been in the habit of 
advising my patients to add a little red wine to a glass of 
Vichy to remove the flatness of taste before I became 
aware that the mixture becomes dark and unpleasant to 
look at in consequence of the reaction between the iron 
of the water and the tannin of the wine. 

It is evident that the waters are to be classified as 
alkaline waters, including those of Vals, Ems and Fach- 
ingan. While sodium bicarbonate is the chief mineral 
ingredient, the physicians at Vichy are not inclined to 
ignore the other constituents, small as their quantity is. 
They say, perhaps with reason, that these are essential 
to its full properties as the tartaric salts, the tannin and 
ether to wine, to say nothing of Nature's handicraft in 
contributing the bouquet of the latter; and that one 
may as well expect to make good wine by adding 
10% of alcohol to water as to make true Vichy by add- 
ing sodium bicarbonate to plain water. As stated, the 
temperature of the waters at the springs varies decid- 
edly, the warmest, Chomel, being 45° C. (113° F.), 
Grande-Grille 44° C. (111.2° F.), essentially the 
same; that of PHopital is 31° C. (87.8° F.); of the 
Pare 18° C. (64.4° F.); Mesdames 15° C. (59° F.); 
Hauterive 14° C. (57.2° F.), while that of Celestins 
is 12° C. (53.6° F.) . The most agreeable water to drink 
at the springs is, therefore, the Celestins because the 



232 SELECTED ADDRESSES 

coolest, though the Pare, the Hauterive and Mesdames 
are also agreeable for the same reason. As at Carlsbad 
so at Vichy, the warmer waters are spoken of as the 
stronger and more active. 

THERAPEUTIC USES OF THE WATERS 

The two principal methods of using the waters are by 
drinking and bathing. All authorities agree that the 
internal method is by far the more important. Not- 
withstanding the similarity of composition, the phy- 
sicians of Vichy specialize the internal use of the waters 
to a degree which would not seem justified from the 
standpoint of chemical composition. Such effect can 
only be explained, as Dr. Raymond Durand-Fardel 
says in one of his papers, 1 by supposing a sort of elect- 
ive affinity between the different waters and the organs 
affected. These elective effects, he says, have come 
to be acknowledged by physicians and public alike. 
Briefly, it amounts to this, that FHopital is the water 
for the stomach and intestines, the Grande-Grille for 
disease of the liver, while the Celestins is especially 
efficacious in affections of the kidneys, the urinary 
passages and bladder. 

Not only this, but contra-indications are pointed 
out which limit the application of the waters. These 
contra-indications include acute, congestive and irri- 
table states of the various organs, recent lesions and 
lesions easily cured, while the waters are especially 
indicated in chronic and torpid states. Thus, quoting 
Durand-Fardel again, in a case of acute biliary lithiaiss 
in a person of nervous or congestive habit the waters of 
the Grande-Grille ought to be avoided, whereas in 
cases of chronic hepatic engorgement with torpidity, 

1 Indications et Contre-Indications de la Cure de Vichy. Reprint 
from the Gazette des Eaux, Paris, 1899. 



PHYSICIAN'S HOLIDAY AT VICHY 233 

in old malarial subjects, or in the chronic stage of 
biliary lithiasis, these waters are especially indicated. 

The waters of Vichy stand strong in contrast to those 
of Carlsbad in being in no degree laxative. On the 
other hand, they have a slight tendency to produce 
constipation, doubtless due to the iron they contain. 
They have the effect of increasing the renal secretion, 
of making the urine alkaline and of maintaining this 
alkalinity as long as their use is continued. In addition 
to the properties alluded to, there is claimed for Vichy, 
as for other mineral waters, a general and a local effect, 
the former influencing nutrition in general, impressing 
the diathesis, the latter being elective for organs. The 
former is shared by all waters alike, the Mesdames and 
Hauterive springs being, on account of their larger 
proportion of iron and arsenic, especially indicated in 
anemia. The waters are usually drunk in divided 
doses a short time before the meal — from two to five 
ounces before luncheon and before dinner. Larger 
quantities are sometimes taken, especially by diabetics, 
who may drink a liter in the 24 hours. 

The general or physiological action of the waters 
taken in moderate quantities during a cure of three 
weeks is thus described: Succeeding its ingestion fol- 
lows a sedative effect on all uncomfortable sensations 
in the stomach. The symptoms of gastric indigestion, 
such as gaseous distension and feeling of weight, dis- 
appear rapidly. This effect is ascribed partly to its 
temperature and partly to direct action of the gaseous 
and alkaline constituents. The secretion of gastric 
juice is stimulated. Hence the appetite is increased, 
sometimes even exaggerated, during the first days of 
the cure. Diuresis is copious, and the acid reaction of 
the urine diminishes until finally alkalinity results and 
is maintained during the use of the water. Oxidation 
is said to be increased and organic changes are accel- 



234 SELECTED ADDRESSES 

erated. In other cases at about the twelfth day signs 
of indigestion appear. The appetite diminishes, the 
tongue b ecomes coated, the bowels, which are usually 
constipated, become loose, probably because of over- 
eating. These symptoms are easily relieved, however, 
by laxatives or an interruption of treatment for a few 
days. 

The physicians of Vichy are emphatic in the belief 
that it is not simply by alkalizing the blood that these 
waters influence so profoundly the gouty diathesis, nor 
by alkalizing the bile and acid urine that it causes hep- 
atic and renal lithiasis to disappear, nor by neutraliz- 
ing the acids of the stomach that it cures dyspepsia and 
counteracts the intense acidity of hyper chlorhydria. 
They insist that they exert a regulating effect upon 
assimilation; that they excite cellular reactions, espe- 
cially upon the cells of the organs of assimilation, viz., 
the liver, the kidneys, the stomach and intestines. 
That alkalization may be a factor they admit ; that it 
is the sole mode of action they deny. 

The external treatment is by baths and douches. 
Though of less importance than the internal use of 
the waters, it is still considered of great value in 
furthering the effects derived from drinking only. 
The mineral baths are said to be better borne, admir- 
ably by persons readily fatigued, than baths of plain 
water. The bathing water is commonly made up half 
mineral water and half ordinary water, or Veau douce, 
as they call it. The baths are ordered daily at a tem- 
perature of 35° C. (95° F.) and of half an hour's dura- 
tion. Formerly the bath was continued an hour or 
more. Other modifications as to strength, duration, 
etc., are made as circumstances determine. The baths 
too, have their contra-indications. Among them are 
included idiosyncrasies, the congestive temperament, 
advanced cardiac disease, irritable gout, certain skin 



PHYSICIAN'S HOLIDAY AT VICHY 235 

affections, special susceptibilities of the respiratory- 
apparatus and cases in which the douche is more espe- 
cially indicated. 

The douche is given hot or cold under various 
degrees of pressure. The cold douche is especially 
indicated when it is desired to excite innervation and 
stimulate the circulation; also in cases of torpid ane- 
mia, atonic dyspepsia and in diabetes, when it is 
desired to stimulate tissue metamorphosis. It is 
applicable, too, to neurodyspeptics and neurasthenics, 
and to conditions in which the plunge bath may be for 
any reason contra-indicated. 

The special affections to which the Vichy treatment 
is applicable include quite a long list containing every 
form of dyspeptic derangement, including gastric, 
intestinal and hepatic congestion, gout, renal gravel, 
obesity, arthritic eczema, some rosacea and urticaria, 
the last more especially when associated with gastro- 
hepatic diseases. While the treatment is particularly 
recommended for hypopepsia and hyperchlorhydria, 
seemingly thus to blow hot and cold at the same time, 
the principle of administration is different in the two 
classes of cases. In the former, small doses of the wa- 
ters are recommended and are said to increase the ac- 
tivity of the gastric secretion. In hyperchlorhydria it 
is given freely in association with large doses of the 
alkalis which are intended to neutralize the hyper- 
acidity, while the mineral water regulates the secretion 
of the gastric cells by influencing their nutrition. 

Ulcer of the stomach is included among the diseases 
benefited. While at Vichy, one of the most conserva- 
tive of the resident physicians told me that he had 
come to Vichy originally on account of a severe form of 
gastric ulcer among the symptoms of which were large 
hemorrhages. He felt that he had been cured by the 
use of Vichy waters, which he thought acted diathet- 



236 SELECTED ADDRESSES 

ically rather than locally. So, too, in dilatation of the 
stomach the internal use of the Vichy waters with 
lavage by the same is considered as beneficial. It is 
held that cases of intestinal indigestion are benefited 
at Vichy more especially when they are the result of 
deranged gastric secretion. Among these are included 
the intestinal affections of tropical climates, especially 
Asia and Africa. Hence, the French Government has 
a military hospital at Vichy used by officers and sol- 
diers returning from these countries. But it is the 
very numerous class of gastrohepatic affections which 
are suited to the Vichy treatment — cases with enlarged 
congested liver, with mild icterus, pale tongue and 
deranged bowels, cases of alcoholic, infectious or ma- 
larial origin. Cases of hepatic congestion due to heart 
disease, to dysentery and to other affections of hot 
countries are included in this category. While cir- 
rhosis of the liver is not regarded as amenable to the 
Vichy treatment, the precirrhotic congestive stage of 
alcoholism is. My attention while at Vichy was espe- 
cially called to cases of enlarged liver, apparently con- 
gestive, which responded to treatment with decided 
reduction in size. I have mentioned that various 
forms of nervous dyspepsia associated with neuras- 
thenia are suited to this treatment. These include 
cases in which cardiac symptoms are simulated or 
which may be due to alimentary toxins — ptomaine 
poisons. 

Especial efficiency is claimed for the Vichy waters 
in biliary lithiasis of all varieties, with or without 
hepatic colic, and with or without biliary obstruction. 
The waters are regarded as efficacious, not by exerting 
an expulsive effect upon the stone, but as modifying 
the function of the hepatic cell in such a way as to 
diminish the lithogenic process. Hence local physi- 
cians hold that in all cases, before surgical procedures 



PHYSICIAN'S HOLIDAY AT VICHY 237 

are instituted, a trial of this cure should be made unless 
there be evident danger in delay, due regard being had 
to acute contra-indications represented by inflamma- 
tory complications, including suppurative angiocho- 
litis and cholecystitis. 

Gouty patients have of late years been less numer- 
ous at Vichy, according to Raymond Durand-Fardel, 
because of the unsettled views as to the pathogenesis 
of gout and the apprehension that the alkaline ca- 
chexia or alkaline anemia may add itself to the gouty 
cachexia. The alkaline anemia he regards as an 
imaginary condition the possibility of which is refuted 
by the marvelous effects of the cure of the colonists 
who come to Vichy in large numbers for the cure of true 
anemia acquired by residence in hot countries. As to 
the new views regarding the pathogenesis of gout, if 
we suppose gout to be caused by an overproduction of 
uric acid due to too rapid destruction of nucleins, plus 
deficient renal elimination, the waters may act favor- 
ably by influencing vitiated nutrition including that 
responsible for the renal affection. This is based upon 
the dictum generally accepted that there can be no 
gout without uric acid; and the second dictum promul- 
gated by Levison, of Copenhagen, less generally 
allowed, that with uric acid there can be no gout with- 
out chronic nephritis. 

Special efficacy in renal gravel is claimed for Vichy. 
As with hepatic lithiasis, the Vichy physicians say it is 
not through alkalinity or by flushing the urinary pas- 
sages, but rather by its diathetic influence upon cellu- 
lar metabolism. Lavage of the urinary passages, they 
say, is better accomplished by the sulphated calcic 
waters, of which Contrexville is the type. Simple uric 
acid sediments without calculous concretion or colic 
disappear promptly under the Vichy cure. For many 
years I have been treating uric acid gravel with Vichy 



238 SELECTED ADDRESSES 

water, and it is a rare event for a person thus treated to 
have an attack of colic. My practice is to continue 
the use of the water without intermission. For I have 
known nephritic colic to return when the use of the 
water has been discontinued, and again disappear after 
it was recommenced. For this purpose I find a 
quart daily suffices — one-fourth before each meal and 
at bedtime. I confess I have thought that it was by 
its direct solvent effect through its alkalinity and 
dilution rather than by influencing cell action that it 
acted. I was somewhat surprised to find that no 
efficiency is claimed for Vichy in the cure of oxalic 
diathesis, for, while alkalis exert no solvent action on 
oxalate of lime, the oxalic diathesis appears to be due 
to the same vitiated nutrition as that which underlies 
the uric acid tendency. Naturally, the alkaline dia- 
thesis which is responsible for phosphatic sediments is 
increased by Vichy waters. They are, therefore, 
directly contra-indicated. 

Very little is claimed for Vichy in the treatment of 
albuminuria. When associated with marked Bright's 
disease, it is allowed to be a contra-indication rather 
than otherwise. Associated with gout or gravel, 
albuminuria offers no contra-indication in the absence 
of marked nephritis. The Vichy treatment is held to 
be especially efficacious in the albuminuria associated 
with diabetes, the albumin and sugar disappearing pari 
passu. 

In diabetes, too, great virtue is claimed for the 
Vichy waters. It is admitted, however, that the cases 
benefited are the stout, florid diabetics, with large 
fatty livers and without grave complications like tu- 
berculosis. Acetonuria is no contra-indication. In 
my own practice I am in the habit of flushing with Vichy 
water all my patients threatened with diabetic coma, 
often adding potassium citrate to increase its alkalin- 



PHYSICIAN'S HOLIDAY AT VICHY 239 

ity. On the other hand, the diabetes of the lean, 
whether pancreatic or nervous, receives no benefit. 
The same is true of the diabetes of the young. As the 
first-named variety is that relieved almost anywhere 
by treatment, it is plain that no specifically curative 
virtue can be claimed for the waters. 

Obesity, especially when associated with large fatty 
liver, it is claimed, is also benefited at Vichy, by inter- 
nal use of the water combined with massage and the 
douche conjointly. It is admitted, however, that 
there are no results comparable to those at Marienbad. 

It is evident that efficiency is claimed for both. Carls- 
bad and Vichy in the treatment of the same diseases. 
Is there anything in either cure which makes one more 
suitable than the other? The only effort of which I 
am aware, that contrasts the two cures, is a paper pre- 
pared by the two Drs. Durand-Fardel, father and son, 
in 1895. * Both these physicians were long resident 
in Vichy and have had a large experience with its 
waters. The elder, a member of the Academy of Medi- 
cine and entrusted with numerous responsible posi- 
tions, is lately deceased. The younger I had the pleas- 
ure of meeting at Vichy. I shall draw on their paper 
freely because my own experience with either cure is 
too limited to justify conclusions, while my personal 
examination into the cure and methods at both places 
may in a measure fit me to appreciate their deductions. 

First, to compare and contrast the chemical com- 
position of the waters. Both contain a large propor- 
tion of sodic bicarbonate, the Vichy waters nearly 
three times as much as the Carlsbad — Grande-Grille, 
taken as the type for Vichy, containing 4.88 gm. to 
the liter, while the Sprudel at Carlsbad contains 1.29. 
The Vichy waters are, however, simple sodic bicar- 

1 Carlsbad et Vichy. A Wallon, Vichy, 1895. 



240 SELECTED ADDRESSES 

bonate waters, the sodium bicarbonate being the domi- 
nating constituent, while the Carlsbad are called 
complex sodic bicarbonate waters, containing also 
sodic sulphate and sodic chloride in considerable 
amount, 2.4 gm. and 1.04 gm. respectively. The 
amount of free as well as fixed carbonic acid is consid- 
erably more in the Grande-Grille at Vichy than in the 
Sprudel at Carlsbad. Of both waters it may be said 
that, while they are furnished by many springs, the 
composition of the waters at these various sources is 
nearly the same, the main difference being in the tem- 
perature, some being hot, others intermediate and 
others cold. The first at Carlsbad being represented 
by Sprudel at 73° C. (163.4° F.), the second by 
Schlossbrunn at 49° C. (120.2° F.), and the third by 
Spitalbrunnen at 35.2° C. (95.3° F.). The different 
sources of Carlsbad water, like the different sources 
of Vichy water, differ also in the quantity of carbonic 
acid gas. In general, the warmest waters and those 
most liberally charged with carbonic acid are regarded 
as more stimulating. The Vichy waters, although 
similarly classifiable as to temperature, are of much 
lower temperature, those of highest temperature, 
Grande-Grille, being 42° C. (108.5° F.), Puits 
Chomel 43° C. (109.4° F.), FH6pital 31.7° C. (89° F.), 
and Celestins 14.3° C. (57.5° F.). 

The quantity of water administered and the mode of 
administration also differ. At Carlsbad the water is 
rarely taken except in the morning before breakfast, 
when five to seven ounces are drunk, repeated two or 
three times while the patient is exercising moderately 
by walking slowly up and down the pavilions. At 
Vichy the dose is much less, only two to five ounces 
four times daily before meals. 

In both places bathing is associated with drinking. 
In Vichy as in Carlsbad the baths are advised daily, 



PHYSICIAN'S HOLIDAY AT VICHY 241 

but at the latter place the duration of the bath is lim- 
ited to fifteen or twenty minutes, while at Vichy it is 
half an hour to an hour. In each place a course in- 
cludes twenty to twenty-five baths. Mud-baths for 
the treatment of rheumatism are given at Carlsbad 
only. In both places, too, massage constitutes an 
important part of the treatment, a specialty of Vichy 
being the association of massage with the douche under 
varying pressure, particularly employed in obesity and 
in rheumatism and other arthropathies. At Vichy less 
importance is attached to the baths than to the inter- 
nal administration of the waters. 

It is claimed to be especially characteristic of the 
Vichy treatment that it produces no immediate objec- 
tive effects preceding the beneficial results ultimately 
established — effects revulsive, irritative, eruptive or 
painful — nothing objective save a moderate diuresis. 
Its curative effect, as already stated, is held to be upon 
nutrition and assimilation — in a word diathetic, acting 
" gently and silently." The inference is that this is 
not the case with Carlsbad. But in a recent quite 
prolonged stay at Carlsbad I saw nothing to justify 
such conclusion. It may have been a part of the older 
treatment, when patients were allowed to lie in the 
baths until the skin was macerated, producing irrita- 
tions and excoriations. But this is no longer the prac- 
tice. In fact, the duration of the baths is shorter in 
Carlsbad than at Vichy. 

The Drs. Durand-Fardel contrast the action as fol- 
lows: The two cures, almost identical in appearance 
and ultimate effect, act upon the organism in a very 
different manner. The Carlsbad waters, being to a 
certain degree stimulating to secretions, are best 
suited to lymphatic torpid organisms, while those of 
Vichy, acting without such disturbance, are best 
suited to excitable organisms. As to the liver, for ex- 

16 



242 SELECTED ADDRESSES 

ample, chronic engorgements, such as are caused by 
malaria, are best treated at Carlsbad, while the treat- 
ment at Vichy is best adapted to hepatic colic. These 
physicians say it is not unusual for biliary colic to be 
excited under Carlsbad treatment, while this is rarely 
the case at Vichy, especially under the use of the water 
of l'Hopital spring, which appears to be especially 
recommended. So, too, abdominal plethora and its 
consequences are best treated at Carlsbad. And this 
is conceded by the Vichy physicians. They claim, 
moreover, that the Vichy cure is better adapted for 
affections limited to the stomach, while the waters of 
Carlsbad exercise their influence more especially on the 
intestines. 

As to the dietetic regime which has long been famous 
for its rigidity at Carlsbad and its liberality at Vichy, 
ignoring for the present the fact that the extreme rigid- 
ity formerly insisted upon is no longer practised at 
Carlsbad, the physicians at Vichy say that a special 
dietary — a regime des eaux — is necessary at Carlsbad 
because of the disturbing effect of its waters and the 
large amounts in which they are taken. At Vichy, on 
the other hand, the tolerance of the treatment com- 
ports with a corresponding tolerance of diet. Hence 
it is that the table d'hote is not encouraged at Carlsbad, 
while at Vichy it is the prevailing mode. 

On the other hand, the physicians at Vichy do not 
wish to be considered as indifferent to diet, and hold 
that there is prescribed for each patient a regimen 
suited to his case, rather than a diet demanded by the 
medication itself. An interesting illustration of differ- 
ences actually practised is seen in the matter of fruits. 
It is well known that at Carlsbad great stress is laid 
upon the use of cooked fruits as contrasted with raw 
fruits, while at Vichy raw fruits are permitted. This 
quite reasonably, since at Vichy the stimulating and 



PHYSICIAN'S HOLIDAY AT VICHY 243 

laxative effects of the raw fruits are desirable to coun- 
teract the slightly constipating tendency of the waters, 
while at Carlsbad, since the waters are aperient, no 
effect of this kind is needed, indeed is to be avoided, 
while the otherwise wholesome influence of fruits is 
indicated. 

As to other treatment involving the use of water, in 
addition to the douches already alluded to, it includes 
appliances for irrigations of the various cavities of the 
body, including the stomach, bladder, rectum and 
vagina, either by means of mineral or indifferent 
waters. A special feature is the carbonic acid bath 
employed for neuralgic pain, general pruritis and the 
treatment of gouty subjects who dread the application 
of water. Inhalations of carbonic acid gas are also 
employed in certain forms of dry asthma, angina and 
chronic coryza. 

As to the mechanotherapy at the two places, it is 
essentially the same. Both places are equipped with 
well-appointed Zander Institutes, both under the con- 
trol of accomplished physicians, Tyrnauer at Carlsbad, 
and Vermeulen at Vichy. Dr. Vermeulen showed me 
some very interesting effects of the vibrating treat- 
ment, as applied to the wrists and ankles, upon vaso- 
motor regulations. The application of this to the 
treatment of diabetes mellitus he promised to embody 
in a paper to be sent to me, and which I hope to be able 
to read before this Section before the winter is over. 
He also showed me some striking pulse tracings exhib- 
iting the effect of the mechanotherapeutic treatment 
upon lost compensation in cardiac and vascular dis- 
ease. Among other affections treated in the mechan- 
ical institute are articular gout and rheumatism, 
obesity and affections of the lungs. No more inter- 
esting place can be found than this room with its 
numerous appliances propelled by machinery, all in 



244 SELECTED ADDRESSES 

active operation and in use. The scene is a very busy 
one. Dr. Vermeulen told me that his department 
had already outgrown the space provided for him in 
the new bath-establishment, and it will have to be 
enlarged in another year. 

At both places are prepared by evaporation the 
dry salts — the Carlsbad salts and Vichy salts, Sels 
Vichy-etat. In them are contained all the solid in- 
gredients of the waters. These are exported in large 
quantities and are very convenient for travelers' use 
when dissolved in hot or cold water, for drinking or 
bathing. Naturally, they are an imperfect substitute 
for the actual waters. We visited the factory at 
Vichy where this preparation is carried on on a large 
scale and found it very interesting. In the evaporat- 
ing process the carbonic acid is liberated from the 
sodium, but is again restored to it by an ingenious 
process, the carbonic acid being derived from its 
natural source, the springs the waters of which by 
evaporation furnish the salt. 

As to my own conclusions, so far as they are justified, 
I have no doubt that there are many minor condi- 
tions which are equally well treated at Carlsbad and 
at Vichy, cases in which change of scene, diversion 
and a restful life alone are needed. I believe the 
Vichy physicians are right, too, in saying that pure 
gastric derangements, such as deranged secretion and 
fermentation processes, are better treated at Vichy, 
while cases requiring depletion of the liver and upper 
alimentary canal are better treated at Carlsbad. So 
I should be inclined to refer cases of hepatic torpor, 
biliary lithiasis and gout to Carlsbad. On the other 
hand, renal lithiasis of the uric and oxalic kinds, I 
should certainly refer to Vichy. I do not think it 
makes much difference to which place one sends dia- 
betics, for it is only the mild cases which are benefited 



PHYSICIAN'S HOLIDAY AT VICHY 245 

at either place. I am inclined to think the needed 
dietetic regimen is rather more easily carried out at 
Carlsbad, while the alkalinity of the Vichy waters 
adapts them rather than the purgative waters at 
Carlsbad, though the depleting effect of such waters 
on the liver is also helpful to diabetics. Carlsbad also 
seems better suited to the stout and strong and pleth- 
oric with phlegmatic temperament, while Vichy is 
suited to the delicate, the nervous and those to whom 
active treatment is harmful. Finally, persons in 
whom there is a tendency to looseness of the bowels 
should go to Vichy rather than to Carlsbad. - 

When to go to Vichy. "The season " at Vichy com- 
mences the 15th of May and ends the 30th of Sep- 
tember, but the baths are available throughout the 
year, and, of course, the waters for drinking as well. 
For the purposes of the cure April and May, or Sep- 
tember and October, are very pleasant periods, but 
the months of June, July and August are those in 
which Vichy is most frequented. Hence, at this sea- 
son there is more going on in the way of gaiety and 
diversion. The theater and concerts are in full 
swing, the Casino is crowded in the afternoon and 
evening by promenading visitors from all sections, 
and the scene is one of great gaiety and brilliancy. 



XV 
A PHYSICIAN'S HOLIDAY IN THE 

ENGADINE 



XV 

A PHYSICIAN'S HOLIDAY IN THE 
ENGADINE 1 

The words, St. Moritz in the Engadine, had been 
ringing in my ears ever since, as a young physician, 
I first read them in the Medical Times and Gazette, 
that excellent journal then published by the Churchills, 
but long since discontinued; while Ragatz and the 
equally cacophonious Pfaffers have been staring at 
me from the pages of text-books for so many years 
that I determined my next holiday should make me 
more familiar with this district. Landing at Antwerp, 
I could not resist the temptation to spend a day in 
beautiful Brussels, to peep again into Cologne Cathe- 
dral and repeat the Rhine trip, but by August 5 I was 
in Ragatz, whose waters have long had a reputation 
for the cure of a long list of maladies, including chronic 
rheumatism and gout, joint affections of traumatic 
origin, nervous diseases, including neurasthenia and 
neuritis, especially sciatic neuritis, diseases of the 
brain and spinal cord, gastro-intestinal and bronchial 
catarrh, renal and bladder affections and diseases of 
women. The number is too many and varied to 
inspire confidence, although it is not unlikely that any 
one or all of these ills may be favorably influenced by 
the hydrotherapy here practiced, associated as it is 
with mechanotherapeutics by the Zanders' apparatus, 
scientific massage, electricity and various dietetic 
cures. Nor does the chemical composition of the 
thermal waters of Ragatz inspire more confidence, 

1 Reprinted from The Journal of the American Medical Association, 
May 1, 1909, Vol. LII, pp. 1400 and 1401. 

249 



250 SELECTED ADDRESSES 

for although the ingredients are many they are not 
present in quantity sufficient to justify the term 
" mineral," since the water has a total of only three 
parts of solid matter in 10,000. The solids include 
iron, aluminium, calcium, strontium, barium, magne- 
sium, potassium, sodium, lithium, ammonium, and 
numerous others, all in very minute proportions, not 
omitting radium, as attested by the attendant who 
showed me the baths. The most abundant constitu- 
ent is carbonic acid, which is represented by one of 
the three parts. To this and to the temperature of 
the water may be due its efficiency. Its source is 
Pfaffers a couple of miles distant, where the water 
gushes out of the earth with a temperature of 98.6° 
F., whence it is piped down to Ragatz. A cure house 
was built at Pfaffers in 1242 by the abbots of Pfaffers, 
and remnants of it still remain. The present house 
was built in 1714, and is still a popular resort, although 
much shut in and therefore gloomy on other than 
bright days. The valley of the Tamina which con- 
nects the two health resorts of Ragatz and Pfaffers, 
widens out from the famous Tamina gorge into a 
broad valley, in which lies the pretty town of Ragatz, 
with its two large hotels, the Quellen hof and Hof 
Ragatz, with their extensive grounds, Cursalle, Casino, 
and baths, into which is poured an abundant supply 
of hot water from Pfaffers by the method above 
described. 

There is nothing peculiar in the baths themselves. 
They are taken in porcelain lined tubs sunken below 
the floor, and are available not only on the grounds 
of the two great hotels, but as well at the cure house 
in the center of the town, where, too, the fine orchestra 
gives its concerts, alternating with those at the Casino 
on the hotel grounds. In the latter there is a large 
swimming pool. The^ popularity of the baths is at- 



PHYSICIAN'S HOLIDAY IN THE ENGADINE 251 

tested by the annual visitation of 30,000 visitors, of 
whom presumably a number are tourists and observers. 
The season of Pf affers is from June 1 to September 1 ; 
at Ragatz from May 1 to October 1. English visitors 
are more numerous early in the season. When I was 
there in early August there were a few of the latter, 
German and French being almost the only languages 
spoken. Numerous walks and drives, the ravishing 
music, and the grand mountain scenery made easily 
accessible by a funicular railroad make the two places 
most attractive residences for a time. 

From Ragatz to St. Moritz, in the heart -of the 
Engadine, is a four hours' journey over the Albula 
pass by the Rhaetian railroad in which scenery and 
marvelous construction vie with each other in absorb- 
ing the attention of the traveller. The railway climbs 
by many windings upward, until one is dizzy with 
the height, and a curious sensation in the ears when 
talking, and a feeling of nervousness indicate that the 
circulation is being influenced. It is, however, a 
matter of a few minutes only, for soon the descent is 
commenced, and as it is made more rapidly than the 
ascent, the equilibrium is soon re-established. 

Almost every one forms a conception of a place of 
which he has heard much and looked forward to visit- 
ing, a picture generally quite erroneous. Such was 
my conception of St. Moritz. I had supposed that 
by stage one would travel slowly upward from the 
railroad station to an expanded plateau in the center 
of which would be a single or perhaps two hotels and 
a Kursaal where there were many invalids including 
consumptives, and that in winter this plateau was 
covered with snow. Instead I found many omnibuses 
at the station representing as many hotels. It is 
true we wound our way upward, passing several huge 
and luxuriously appointed hotels to our own, which 



252 SELECTED ADDRESSES 

was the highest in the Dorf, or village, not on a plateau, 
but on the mountain side. There are others equally 
large and sumptuous as well as many smaller hotels 
collected about the site of the springs or St. Moritz- 
Bad. This, at one time isolated from the Dorf, has 
become continuous by the hotels and shops lining 
the road down from the latter, the whole forming a 
handsome village of white houses over 6,000 feet 
above the sea — a village scattered over the hillside 
and around the lake, with a permanent population of 
several hundred and a summer population of as many 
thousands — but nowhere any evidence of patients or 
sick people. Instead are seen gaily dressed women 
and natty men, with here and there a man or woman 
more appropriately dressed for mountain climbing, 
armed with the familiar Alpine stock. 

Not that there are no sick to be found here. They 
may be seen at the baths, none looking very ill, and 
apparently no consumptives at all. For what then 
do persons go to St. Moritz? The largest number 
doubtless for the bracing air and the delightful pas- 
times of golf, tennis, mountain climbing and walking. 
Moreover, the sick are not very sick. This was not 
only my conclusion in my daily visits to the baths, 
for I took them myself, but it was the testimony of 
the older diener who prepared the baths in the men's 
sections. When asked why they did not make use 
of the Zander and other more complicated apparatus 
for mechanotherapy and hydrotherapy, he replied 
that the invalids who came here were more especially 
those who needed rest and the simpler therapy of tub 
bathing in carbonated water as a sort of after-cure. 
Nor was there any specialized bathing as prescribed 
by physicians, such as douche and needle baths, but 
the bather himself gave directions as to the tempera- 



PHYSICIAN'S HOLIDAY IN THE ENGADINE 253 

ture and duration, perhaps after consultation with a 
physician. 

The waters have as their distinctive constituents 
iron and carbonic acid. The former is easily recog- 
nized by the taste and constitutes the chief object 
for the internal use of the water by drinking. For 
bathing purposes, it is commonly used at a tempera- 
ture of 28° Reaumer, 35° C. or 95° F. As to actual 
conditions for which the baths are taken, in addition 
to simple anemia, asthenia and weariness, chronic 
rheumatism and cardiac weakness are conspicuous. 
I can testify in my own case as to the rejuvenation 
which succeeded a course of ten baths at a tempera- 
ture of 97° F. each of ten minutes' duration. The 
bathers rest quietly in the bath in order to permit the 
attachment to the skin of little bubbles of gas which 
arise in a shower of millions with the least movement. 
The skin is rendered visibly red by the attached 
bubbles which thus act as a gentle but widely diffused 
counterirritant. 

As is usual in Europe, the baths are divided into 
first, second and third class, the only difference being 
in the appointments of the bath room. The first-class 
baths are provided with porcelain-lined tubs, the sec- 
ond class with tin-lined tubs and the third class with 
wooden tubs, all scrupulously clean and almost equally 
inviting. The first-class baths are provided, too, 
with warm towels, which are very agreeable. 

Another health resort in the Engadine worthy of 
mention is Tarasp in the lower Engadine, which has 
received the appellation of the " Karlsbad of the Enga- 
dine," from the fact that the waters are of like com- 
position, though cold instead of hot, and are used in- 
ternally and externally for like purposes, viz., chronic 
gastric and intestinal catarrh, enlargement of the liver, 
gout, rheumatism and diabetes. Tarasp and Schultz- 



254 SELECTED ADDRESSES 

Tarasp in the near vicinity have the advantage of 
Karlsbad in the more bracing air, while they are. at 
a disadvantage because of more limited choice of 
pleasurable diversion, exercise and diet. A medical 
friend who had taken the Karlsbad treatment took 
this year the Tarasp treatment with like beneficial 
results. 

Where, then are the consumptive patients for whose 
treatment the Engadine has become so famous, and 
for whom I looked in vain at St. Moritz, and likewise 
at Pontresina and the adjacent Samaden? Davos 
Platz in the Davos valley 20 miles distant, has become 
the haven of consumptives. It, too, is 5,000 feet 
above the sea and well sheltered. Here the amuse- 
ment as well as treatment of consumptives is provided 
in winter and summer in the well-appointed and sun- 
exposed sanatorium. Patients with allied and as- 
sociated conditions, such as bronchial catarrh, pleurisy 
and its products, scrofuloses, nervous asthma and 
neurasthenia are received. 

A few words in conclusion on the rare beauty of the 
Engadine. The word Engadine means the Valley 
of the Inn — the river Inn, which arises in the melting 
ice and snow of the Italian border and gathers strength 
and volume as it flows northward and eastward to 
Insbruck, the Tyrol and the Danube into which it 
ultimately flows at Passau. At St. Moritz, 6,000 
feet above the sea, it widens out into the beautiful 
azure Engadiner See, a lake about a mile long and a 
quarter of a mile wide, in which of a clear day one can 
see reflected the bordering Alpine peaks; over its 
surface move numerous and varied crafts, usually 
manned by Italian boatmen and propelled by sail 
and oar and freighted with pleasure seekers. From 
the porticos of the Engadiner Kulm Hotel a beautiful 
panorama of snow-capped peaks stretches away to 



PHYSICIAN'S HOLIDAY IN THE ENGADINE 255 

the south and beyond. In midsummer the air is 
cool, sometimes almost too cool for comfort, but clear, 
invigorating and rejuvenating, and it is not surprising 
that summer after summer and even winter after 
winter the same families resort to St. Moritz for the 
bracing air and summer and winter sports. The 
valley is about 60 miles in length and includes the 
adjacent villages of Pontresina, Samaden, Cresta, 
Silva Plana, Sils and Maloja in the upper Engadine, 
and in the lower Engadine Tarasp and Schulz-Tarasp. 



XVI 
ADDRESS OF THE PRESIDENT 



DEDICATION 

OF THE 

NEW HALL OF THE 
COLLEGE OF PHYSICIANS 

OF PHILADELPHIA 



XVI 

ADDRESS OF THE PRESIDENT AT THE 
DEDICATION OF THE NEW HALL OF 
THE COLLEGE OF PHYSICIANS OF 
PHILADELPHIA 1 



THE FOUNDATION OF THE COLLEGE 

Of the three occupations of men which are dignified 
by the title of profession, namely, the ministry, the law 
and medicine, that of medicine has been especially 
characterized by a desire on the part of its members to 
unite for mutual improvement. While the Law has its 
bar associations with somewhat similar purpose, these 
organizations are few in number, and the synods and 
conventions of the Church have mainly for their object 
law making, disciplining, and other executive func- 
tions. On the other hand, medical societies organized 
for the object named have existed for centuries and 
have generally arisen whenever the number of physi- 
cians in a community became sufficient to form an 
association. Thus the Royal College of Physicians of 
London, which was evidently in the minds of our fore- 
fathers when they projected the College of Physicians, 
was founded in 1518, the Medical Society of London in 
1773, the Royal College of Physicians, Edinburgh, was 
founded in 1681, the Royal College of Surgeons, Edin- 
burgh, was chartered in 1505, the Faculty of Physicians 
and Surgeons, Glasgow, was instituted in 1599, Gesell- 
schaft deutscher Naturforscher u. Aerzte (Leipzig) was 
founded in 1822, Societe de Medecine de Lyon in 1789, 
Real Academia de Medicina de Madrid in 1732, and 
Academie de Medecine de Paris in 1820. Having been 

1 Reprinted from the Transactions of the College of Physics of 
Philadelphia, 1909. 

259 



260 SELECTED ADDRESSES 

selected to represent nationalities as well as dates, it 
will be observed that while some of these societies 
have been in existence for several centuries, others 
were formed more recently than our own College of 
Physicians. 

The first effort of the kind in the English Colonies of 
North America appears to have been in Boston, in 
1735, when an association was formed which seems 
never to have acquired any other name than that of a 
Medical Society in Boston, as shown in the following 
extract from a letter written February 18, 1735, by 
Dr. William Douglas, of Boston, to Dr. Cadwalader 
Colden, of New York: 

" We have lately in Boston formed a medical society, 
of which this gentleman, a member thereof, can give 
you a particular account. We design from time to 
time to publish some short pieces. There is now ready 
for press number one with this title page." Then 
follows a list of papers which for some reason were 
never published. Several allusions were made to this 
society under this name during the next few years, 
and it continued in existence until at least 1741. 

A society to which is given by Packard 1 the honor of 
the second place in chronological order of American 
Medical Societies was one entitled, A Weekly Society 
of Gentlemen in New York, to which was presented an 
" Essay on the nature of ye Malignant Pleurisy, that 
proved so remarkably fatal to the inhabitants of 
Huntington, Long Island, and some other places on 
Long Island in the winter of the year 1749, drawn up at 
the request of a Weekly Society of Gentlemen in 
New York, and addressed to them at one of their 
meetings, by Dr. John Bard, New York, 1749." No 
other mention of this Society is known. 

1 Packard's History of Medicine in the United States, Philadelphia, 
1891, p. 375. 



DEDICATION ADDRESS 261 

Nor was the College of Physicians the first medical 
society formed in Philadelphia. The first in this city 
and the third in America was the Philadelphia Medical 
Society, organized February 4, 1765, twenty- two 
years earlier than the College, by Drs. John Morgan, 
J. Kearsley, Jr., Gerardus Clarkson, James A. Bayard, 
Robert Harris, and George Glentworth. It appears to 
have been limited in membership, 1 and continued in 
existence only until November 11, 1768, when it was 
joined to the American Society for Promoting Useful 
Knowledge, which became subsequently the American 
Philosophical Society. On November 11a number of 
the members of the Medical Society attended and were 
appointed a standing committee to consider and report 
upon matters relative to physic. The members at the 
time of fusion, in addition to those above named, were 
Drs. Graeme, Cadwallader, Redman, Rush, Souman, 
and Potts. 2 

A number of papers were published under these aus- 
pices, first in the newspapers, which were the chief 
media of distribution of all knowledge in that day, and 
also in octavo form. Dr. George Norris, in his " Early 
History of Medicine in Philadelphia, published by his 
son, Dr. Wm. F. Norris, says, " Several of these essays 
in book form are in my possession." He names as 
among them: "An Essay on the Virtues and Uses of 
Several Substances in Medicine that are the Natural 
Growth of America;" "A Dissertation on the Causes, 
Nature, and Treatment of Apoplexy;" "On the 
Dry Belly Ache, or Nervous Colic;" "On Catarrhal 
Peripneumonia;" and "On Consumption." 

The New Jersey Medical Society, the fourth in 
chronological order of the Colonial societies and the 

J Op. eit., p. 377. 

2 See an extract from a letter from Dr. Rush to Dr. Morgan in 176S, 
in Carson's History of the Medical Department of the University of 
Pennsylvania, 1889, pp. 221 and 222. 



262 SELECTED ADDRESSES 

oldest of existing medical societies, was organized in 
1766. 

A medical society was in existence in New York 
in 1769, and to it was given the credit of instituting 
the " Medical School in King's College." At least 
so said Dr. Peter Middleton at the opening of this 
Medical School, November, 1769. It appears to have 
been known by no other name than Medical Society, 
and would be the fifth in order of age. There would 
seem to be some reason to believe that this society 
was continued under the name of the Medical Society 
of the State of New York, since on November 14, 
1794, "A number of Medical Gentlemen wishing to 
associate for the purpose of promoting friendly pro- 
fessional intercourse, met at the City Hall," New 
York, and " after some conversation on the subject 
of the meeting, it was unanimously resolved that the 
present associates will, on the dissolution of the Society 
known by the name of the 'Medical Society' form 
themselves into a Society by the name and style of 
the Medical Society of the State of New York, and 
that they will use the seal of the same." Stephen 
Wickes, medical historian of New Jersey, found in the 
library of the New York Academy of Medicine a 
manuscript entitled "Minutes of the Medical Society 
of the State of New York," from November 14, 1794, 
to July 8, 1806, which would seem to confirm the 
suggestion above made, though it is strange that in the 
long interval between 1769 and 1794 there should be 
no other evidence of the existence of this society 
mentioned by Dr. Middleton. As Packard says, 
"there is too great a hiatus in our knowledge of the 
existence of a society to warrant a belief that one had 
remained in continuous being through all these years." 
I will, however, regard them as one andtherefore the 
fifth society. In 1806 this Medical Society of the 



DEDICATION ADDRESS 263 

State of New York became the Medical Society of 
the County of New York. 

The American Medical Society, the second of the 
Philadelphia societies and the sixth of all, was founded 
in 1773, by medical students attending lectures in 
Philadelphia. The meetings were held every Monday 
evening during the session and the society continued 
in existence until 1793. It consisted of Junior and 
Senior members, and among the latter were some of 
the most eminent physicians and teachers in Phila- 
delphia. In 1790 its president was Wm. Shippen, 
Jr., M.D.; its vice-president, William B. Duffield, 
A.M.; treasurer and perpetual secretary, Henry B. 
Stuber, M.D.; and annual secretary, John Baldwin, 
A.M. Thus it will be seen that two of the officers 
were undergraduates in Medicine, but they were 
graduates in Arts. This society continued in exist- 
ence about twenty years, or six years after the organi- 
zation of the College of Physicians, in 1787, but the 
exact date of its demise does not appear. I have 
recently seen one of the diplomas or certificates of 
this society signed by William Shippen, Jr., as presi- 
dent, issued in 1793 to Adam Seybert, who later 
became a Fellow of the College. 

"The Boston Medical Society" was organized May 
14, 1780, with the object of regulating physicians' 
fees. The Massachusetts Medical Society, which still 
exists, was founded in 1781, the Medical Society 
of New Haven County, Conn., 1784. These three 
would be the seventh, eighth, and ninth in chrono- 
logical order. The above named are, as far as dis- 
coverable, the medical societies formed prior to the 
College of Physicians January 2, 1787. In the same 
year were organized the Delaware and South Carolina 
Medical Societies; in 1791, the New Hampshire 
Society; in 1792, the Connecticut State Medical 



264 SELECTED ADDRESSES 

Society; and in 1799, in Maryland, the Society known 
as the Medico and Chirurgical Faculty of the State 
of Maryland. 

The College of Physicians, therefore, while the third 
of the medical societies organized in Philadelphia, was 
the tenth of American societies, and so far as can be 
learned, the oldest in existence of American societies 
which is not a State organization. As already stated, 
its prototype was undoubtedly the Royal College 
of Physicians of London, as the Royal Society was 
of the American Philosophical Society. As early as 
1767 that accomplished and indefatigable physician 
and travelled scholar John Morgan, who two years 
earlier had founded the Medical School of the College 
of Philadelphia, later the University of Pennsylvania, 
began to agitate the subject of a College of Physicians, 
but was rather severely sat upon by one of the pro- 
prietors, Thomas Penn, who wrote to Richard Peters, 
February 25, 1767, as follows: "I have had a letter 
from Dr. Morgan and proposals for erecting a College 
of Physicians. I think it very early for such an es- 
tablishment, and wish the faculty would not press 
for such a thing. I shall confer with Dr. Fotherill 
upon it." Suiting the action to the word, the pro- 
prietors refused to grant a charter, and the project 
was abandoned for the time being. 

Physicians of good repute and even eminence in 
the mother country appeared early on the scene in 
the settlement of Pennsylvania. Among them were 
Thomas Wynne, Thomas Lloyd, and Griffith Owen. 
Wynne and Owen were Welshmen. Wynne came 
over with Penn in the " Welcome." Lloyd and Owen 
arrived the same summer, as did also Edward Jones, 
a son-in-law of Wynne. Early in the next century 
came John Kearsley, in 1711, and Thomas Graeme, 
in 1715. Some of these became officers of the 



DEDICATION ADDRESS 265 

Commonwealth, associating with the office the practice 
of medicine or discontinuing the latter altogether. 
John Kearsley became the preceptor of many of the 
most eminent physicians of the next generation. 
Among his apprentices were Lloyd Zachary, Thomas 
Cadwalader, Wm. Shippen, Sr., Thomas and Phineas 
Bond, Cadwalader Evans, John Redman, John Bard, 
and John Kearsley, Jr. As young men grew up in the 
province who studied medicine, they supplemented 
their apprenticeship, when possible, by studies abroad. 
Even after the medical school of the College of 
Philadelphia was started, in 1765, the young men 
who could afford it completed their studies in Edin- 
burgh, London, Paris, and Leyden. Thus, Morgan, 
Shippen, Jr., Rush, and Kuhn, after graduating at the 
Medical School of the College of Philadelphia, spent 
several years abroad and received the degree of 
Doctor of Medicine from the University of Edin- 
burgh. This intercourse resulted in a close intimacy 
between certain of the leading physicians of London 
and E dinburgh and some of those of the c olonies . This 
intimacy was interrupted for a time by the Revolution, 
but was quickly resumed after the war, and many 
Philadelphians again went abroad to finish their 
studies. Representing the best and most wealthy 
families, they were admitted to corresponding circles 
in England, and enjoyed the best opportunities 
obtainable. Correspondence was active not only 
between them and their teachers, but also between 
others. Thus, Dr. Samuel Powell Griffitts, an Ameri- 
can student in London, wrote, August 10, 1783: 

"Your idea of an American College of Physicians 
is what has several times occurred to me." Again 
the celebrated London physician, Dr. John C. Lett- 
som, wrote, September 8, 1783: "I think were I 
in Philadelphia I would not only have a Philosophical 



266 SELECTED ADDRESSES 

Society like our Royal Society or the French Acad6mie 
des Sciences, but likewise a medical college taking in 
likewise foreign members. " Thus was our College 
of Physicians foreshadowed. 

It was not long before this shadow became sub- 
stance. It is evident that, as is usual, one or more 
preliminary meetings had been held, that the project 
was talked over, and it was agreed that there should 
be senior and junior Fellows, as recorded in the minutes 
of the first meeting, January 2, 1787. Officers were 
appointed and a copy of the constitution presented 
and signed by those present. The signers were John 
Redman, John Jones, Wm. Shippen, Jr., Adam Kuhn, 
Benj. Rush, Thomas Parke, Gerardus Clarkson, 
Samuel Duffield, and James Hutchinson, Seniors; and 
William W. Smith, Andrew Ross, William Clarkson, 
James Hall, and William Currie, Juniors. From the 
constitution, which was printed a month later in the 
Pennsylvania Packet and Daily Advertiser, February 1, 
1787, we learn there were to be twelve senior Fellows 
who alone were eligible to office, and any number of 
junior Fellows and associates. The seniors were to 
be chosen from the juniors. The junior Fellows were 
to consist of such practitioners of physic as were of 
good moral character and decent deportment and were 
not under twenty-four years of age. The associates 
were to be selected from "such persons of merit in 
the profession of medicine who do not live within the 
limits described for Fellows, that is, Southwark or 
Liberties of Philadelphia, without any regard to diver- 
sity of nation or religion." 

Nothing is said in the minutes of this meeting of 
the election of officers, but at the time of the publica- 
tion of the constitution in the Packet and Advertiser 
the names of the officers were published. They must, 
therefore, have been chosen at a previous meeting. 
At that time Dr. John Redman was chosen president, 



DEDICATION ADDRESS 267 

but did not deliver his inaugural until some time later, 
but no date is given and no mention is made anywhere 
in the minutes of the exact date of its delivery. In 
it Dr. Redman speaks of having accepted the appoint- 
ment by a " tacit consent/' but that on his return, 
under a strong impression of the weight both of the 
office and his obligation to the Fellows, he wrote what 
seemed to him a suitable address, to be delivered at 
the next or some future meeting. At the second 
meeting he says he was unavoidably absent. Hence 
the address was delivered at a third meeting. But 
exactly when that third meeting was will probably 
never be known. It is quite possible it was a pre- 
liminary meeting, as is evident from the following ex- 
tract from the Quarterly Summary of the Transactions 
for November and December, 1841, and January, 
1842, by Dr. Henry Bond, then Secretary of the 
College: "The College of Physicians was instituted 
toward the close of the year 1786; the first meeting 
after its full organization was held on the second of 
January, 1787." 

Dr. Redman was sixty-five years old when elected 
president of the College, and said a great deal in his 
inaugural about his infirmities and deficiences, but 
nevertheless held office eighteen years, resigning two 
years before he died, at the age of eighty-six, during 
which time the College had attained a lusty adoles- 
cence. The vice-president was Dr. John Jones, son 
of Dr. Evan Jones, grandson of Dr. Edward Jones, 
and great grandson of Dr. Thomas Wynne, who came 
over with Penn in the ship " Welcome." Gerardus 
Clarkson was the first treasurer and James Hutchin- 
son the first secretary. The Censors were Win. 
Shippen, Jr., John Morgan, Benjamin Rush, and 
Adam Kuhn. The constitution provided that the 
officers should be chosen annually, and this practice 
continues to the present day. 



268 SELECTED ADDRESSES 

At the first meeting also a committee, consisting of 
Drs. Benj . Rush, Benj . Duffield, and Samuel P. Griffitts, 
was appointed to prepare a form of diploma or certifi- 
cate of membership, and a device of a seal for the 
College, and another committee consisting of Drs. 
Wm. Shippen, Jr., Adam Kuhn, and William W. 
Smith, to draft by-laws, after which the College ad- 
journed. Although only the nine senior and five 
junior fellows named above were present at the first 
meeting, at the date of publication of the constitution 
a list of twelve senior and twelve junior members 
was printed in the Packet and Advertiser and these 
have been since regarded as founders. They were 
as copied from the original vol. 1 of the minutes: 

Senior Fellows: 
John Morgan John Redman 

John Jones 
William Shippen, Jr. 
Adam Kuhn 
Benj. Rush 
Gerardus Clarkson 
Samuel Duffield 
Thomas Parke 
James Hutchinson 
George Glentworth 
Abram Chovet 

Junior Fellows: 

Andrew Ross Samuel P. Griffitts 

William W. Smith J. Morris 1 

James Hall B. Duffield 

William Clarkson John Carson 

William Currie John Foulke 

Benj. Say Robert Harris 1 

1 Dr. John Morris forfeited membership in 1789 for non-payment of 
dues for three successive years. January 4, 1803, Dr. Robert Harris 
forfeited membership for the same reason, and at the same meeting 
Dr. Charles Caldwell forfeited membership for a like cause, but he 
was not a founder. 



DEDICATION ADDRESS 269 

In addition to the above names, there also signed 
the first constitution the following Junior Fellows, 
elected April 3, 1787: John Dorsey, John R. Rogers, 
Caspar Wistar, James Cunningham. The name of 
John Lynn is also found in the minutes among the 
Junior Fellows signing the first constitution, but is 
erased, for what cause is unknown. He attended 
one meeting, October, 1787. 

The constitution provided that the meetings should 
be held on the first Tuesday of every month. On 
November 6, 1787, seventeen Fellows being present, 
an amended constitution was adopted, virtually the 
one now in force, whereby the members included 
only Fellows and Associate Fellows, the Junior Fellows 
being discontinued. The entrance fee was three 
pounds, Pennsylvania currency, equal to eight dollars, 
and the annual contribution fifteen shillings, or two 
dollars. Through failure to pay these fees, two of 
the founders forfeited Fellowship. 

The first meeting of the College was held in the 
evening in the old Academy on Fourth Street below 
Arch, where the University was then located. Sub- 
sequently, until 1791, it met in these premises at 
4 p. m. from October to March, and at 5 p. m. from 
April to September. 

The College was incorporated March 26, 1789, in 
accordance with a resolution of Dr. Morgan at a 
previous meeting. This is the only action of Morgan 
except as a donor of books, and occasional member 
present, recorded in the minutes after the organiza- 
tion. To those who are familiar with the part 
Dr. Morgan played in founding the Medical School 
of the University, this is a surprise. But he was 
broken in spirit and health by the unfair treatment 
of his country in removing him from the position of 
Medical Director-General, on charges of which he 



270 SELECTED ADDRESSES 

was ultimately exonerated, but too late. He died in 
October, 1789, little more than two years after the 
College was organized, being then only fifty-four years 
old. He remained a censor up to the time of his 
death. He was born the same year as his colleague, 
Dr. Shippen, Jr., who lived to be seventy-two. 

The first paper read before the College was by Dr. 
Rush, at the second meeting, February 8, "On the 
Means of Promoting Medical Knowledge." At the 
third meeting, March, 1787, the first standing com- 
mittee was appointed, that on Meteorology and 
epidemics. It was for a long time regarded as a most 
important committee, submitting annual reports, 
some of which were made with great care, until March, 
1887, when it was discontinued. Thus was our 
College launched. 

II 

FIRST TWENTY YEARS OF THE COLLEGE 

However interesting the history of the College 
during the first century of its existence, it would not 
be profitable to detail it on such an occasion as this. 
Moreover, it has been quite fully written up for our 
Transactions by one of my predecessors, Dr. Rus- 
chenberger, in the centennial volume — the volume of 
1887. The same is true of biographies of our found- 
ers, excellent sketches having been made by others, 
wherever it has been possible. I will, therefore, only 
speak of some of the more important events in our 
history which may reasonably be expected to be 
interesting. 

The College early assumed a guardianship over the 
health, safety, and even morals of the community. 
As early as April 3, 1787, it appointed a committee 
to submit plans for establishing hot and cold baths 



DEDICATION ADDRESS 271 

and a botanical garden for the city. On September 
4, it memorialized the State Legislature on the subject 
of alcohol, pointing out the harmfulness of spirituous 
liquors on the human body and praying that such a 
law be passed as shall diminish their consumption. 
In 1790 it memorialized the Congress of the United 
States on the same subject. 

In 1788 it initiated action toward the preparation 
of a pharmacopoeia of the United States, and the final 
consummation, in 1829, of this important work may be 
ascribed largely, if not exclusively, to the efforts of 
the College. Since that time it has taken an important 
part in each decennial revision. 

The circumstance which made the first decade in 
the life of the College the most stirring and interest- 
ing in its history was the presence of the yellow fever, 
which first claimed its formal consideration on August 
25, 1793, 1 when a special meeting was held "to con- 
sider what steps the College should take consistently 
with duty to their fellow citizens, in connection with 
the prevalence of a fever of a very alarming nature 
in some parts of the city." Drs. Rush, Hutchinson, 
Say, and Wis tar were appointed to consider the 
subject and report the next day, August 26. On that 
day it was decided to meet every Monday at 4 p.m. 
"to confer on the treatment of the existing malignant 
fever." 

Directions for preventing the further progress of 
the fever were adopted, as suggested by Dr. Rush's 
committee, signed by the vice-president and secretary, 
and a copy ordered to be sent to the mayor of the city. 
These directions, eleven in number, with comments 
on the inefficiency if not the danger of fires kindled 

1 This was not, of course, the first time yellow fever had prevailed in 
Philadelphia, this city having been visited by severe epidemics in 
1692, 1699, 1741, and 1762. 



272 SELECTED ADDRESSES 

as a means of checking the progress of the fever, and 
placing more dependence on the burning of gunpowder, 
were promptly sent to the citizens. It was further 
stated that "the benefits of vinegar and camphire 
are confined chiefly to infected rooms, and they 
cannot be used too frequently on handkerchiefs or in 
smelling bottles by persons whose duty calls on them 
to visit or attend the sick." 

On September 3 it was ordered that the College 
meet every Tuesday and Friday at 4 p.m. The 
tragedy deepens. On September 17 Drs. Redman and 
Currie are the only Fellows present. After this day 
there is no meeting of the College until November 5, 
when the president submits a note in substance as 
follows: " October 1. The president and secretary, 
as well as many other members, being sick, several 
out of town, and the few remaining being very much 
engaged, the president and secretary, after exchanging 
letters on the subject, had determined not to issue 
notices of meetings." What a pregnant and pathetic 
paragraph was this! Alas! that such courage and 
devotion, such unselfishness and personal sacrifice, 
should have been associated with differences of opinion 
which led to bitterness and recrimination, to lawsuit 
and even personal violence, as well as the alienation 
of friends, and ultimately, on November 3, the resig- 
nation of Dr. Rush, who, whatever his faults, was the 
most eminent and most virile member of the College. 
There were differences of opinion as to origin and as 
to treatment. One set, led by Dr. Rush, held for 
a domestic origin, and another claimed the disease 
was imported. Governor Mifflin wrote to President 
Redman, October 30, 1793, asking whether the dis- 
ease was imported, and if so by what means and at 
what place. If not imported, what were the probable 



DEDICATION ADDRESS 273 

causes producing it? What measures ought to be 
pursued to purify the city from any latent infection? 

A committee, consisting of Drs. Ross, Parke, Currie, 
Carson, Foulke, B. Duffield, and Wistar, was ap- 
pointed to prepare a reply to the Governor's ques- 
tions. This committee submitted a report November 
12, but it was recommitted with request to have the 
facts authenticated. Drs. Say, Leib, and Barton 
were added to the committee. On November 19 the 
committee was discharged. They evidently could 
not agree. Drs. Parke, Carson, and Griffitts were 
then appointed to answer the Governor's questions, 
and on November 26, 1793, a reply was adopted to 
the effect that the fever was imported in vessels about 
the middle of July. Cleanliness of the streets, the 
use of gunpowder as a disinfectant, and of slacked 
lime in privy wells was recommended. 

On December 2, 1794, a committee of the College 
was appointed to consider the defects in the health 
laws and suggest remedies. On the report of this 
committee it was resolved to memorialize the State 
Legislature on the subject. This was done January 
26, the memorial embodying a request that "medical 
characters" should be appointed to assist the consult- 
ing physician of the port to prevent the spread of 
contagious diseases when introduced, and that they 
should be consulted respecting the quarantine and 
purification of vessels and the construction and 
regulation of the City Hospital. 

In response the Legislature passed a new health law 
empowering the governor to appoint four persons, 
members of the College, to assist the consulting phy- 
sician as recommended, who were appointed the 
August following and were invited to meet with the 
Board of Health once, but another law was passed 

18 



274 SELECTED ADDRESSES 

the following session excluding them "from any- 
further share in the business." 

In 1797 the pestilence again burst forth with fury, 
and on August 22 the College was requested by the 
Inspectors of the Board of Health to meet daily or as 
often as convenient to publish such information and 
offer such advice as might in their judgment check 
the spread of the contagion. August 26 the Secretary 
of the Commonwealth requested information as to the 
existing malignant fever. October 24 the Governor 
asked what measures should be used to subdue latent 
infection and to prevent its recurrence. All this to the 
College. On the other hand, the following letter, 
dated Philadelphia, November 6, 1797, and addressed 
to Dr. Rush, speaks volumes: 

Philadelphia, 6th November, 1797. 

Sir : I am desirous to obtain, for the information of the Legisla- 
ture, the most correct account of the origin, progress, andDature 
of the disease that has recently afflicted the city of Philadelphia, 
with a view that the most efficacious steps should be taken to pre- 
vent a recurrence of so dreadful a calamity. I have requested 
the opinion of the College of Physicians on the subject; but as 
I understand that you and many other learned members of the 
Faculty do not attend the deliberations of that institution, the 
result of my inquiries cannot be perfectly satisfactory without 
your cooperation and assistance. Permit me, therefore, Sir, 
to beg the favor of you, and such of your brethren as you shall 
be pleased to consult, to state in answer to this letter the opinion 
which your researches and experience have enabled you to form 
on the important subject of the present investigation. I am 
respectfully, sir, your most obedient, humble servant. 

Dr. Benjamin Rush. Thomas Mifflin. 



The astute Governor evidently was not satisfied 
with the opinion of one party. A reply to this letter, 
undated, and signed by Dr. Rush and twelve others, 
all founders of the recently formed " American 



DEDICATION ADDRESS 275 

Academy of Medicine of Philadelphia," advocated the 
doctrine of the local origin of the fever. 

The report of the College in answer to the Govern- 
or's communication was not submitted until some time 
later, December 24, 1797, when a committee consisting 
of Drs. Kuhn, Currie, Parke, Wistar, Griffitts, and 
James, appointed November 11, submitted a narrative 
of the fever, with a statement as to the best method 
of preventing the invasion of similar diseases in the 
future. It was adopted and ordered printed, January 
2, 1798. The title was " Proceedings of the College 
of Physicians of Philadelphia, Relative to the Pre- 
vention of the Introduction and Spreading of Conta- 
gious Diseases," Printed by Thomas Dobson at the 
Stonehouse, No. 41 South Second Street, Philadelphia, 
1798, pp. 52. It contains the correspondence, me- 
morials and other matters in connection with the 
Proceedings from August 25, 1793, to December 
26, 1797, inclusive. The opinion of the College as 
expressed in the pamphlet was to the effect that yellow 
fever is an imported disease and spreads by contagion, 
an opinion directly opposite to that of Dr. Rush. 

In August, 1798, the fever again broke out. A 
special meeting was held August 6, at which sixteen 
were present, called in consequence of a letter from 
Dr. Wistar to the president, informing him of the 
existence of a malignant fever in the city. A com- 
mittee was appointed to wait on the Board of Health 
to recommend the removal of all families between 
Walnut and Spruce Streets, and the east side of Front 
and the river; also to remove the shipping between 
Walnut and Spruce Streets to a proper distance. 
There was no meeting of the College between 
August 21 and November 6. 

December 11, 1798, a committee was appointed to 
draw up a narrative of the proceedings of the College 



276 SELECTED ADDRESSES 

in 1793 and 1797, and the facts relative to the origin 
and progress of the malignant fever of 1798, with a 
statement of the best methods of preventing the 
introduction of similar diseases in the future. The 
result was the second report, entitled " Facts and 
Observations Relative to the Nature and Origin 
of the Pestilential Fever which Prevailed in this 
City from 1793 to 1797 and 1798." By the College 
of Physicians of Philadelphia. Printed by Thomas 
Dobson, at the Stonehouse, No. 41 South Second 
Street, Philadelphia, 1798, 1800, pp. 52. 

In this pamphlet the College reiterated its previous 
opinion that yellow fever is an imported disease and 
is spread by contagion. 1 

Again, on July 1, 1799, a special meeting was called 
by the president at the request of the Board of Health 
because of the prevalence of an alarming fever. 
Difference of opinion again arose between the College 
and Board of Health. The College favored separation 
of the diseased from the healthy and removing the 
shipping which lay from South to Penn Street to 
a safe distance from the city, evacuating dwelling 
houses, stores, counting houses, and wharves as the 
best means of checking the progress of the disease. 

The Board of Health objected to public notifica- 
tion, fearing that such a course might create a terror 
which would add to the predisposing causes of the 
disease if any exist, and occasion an alarm which must 
injuriously affect the welfare of the city and the in- 
terest of the citizens. It is evident that human 
selfishness worked much the same in that day as at 
present, and that temporizing was as popular then 
as now. After that the College met every other 
evening at eight o'clock, and at a special meeting, 

1 The College published in all three papers or pamphlets on the 
yellow fever in 1798, 1798-1800, and 1806. 



DEDICATION ADDRESS 277 

August 21, 1799, it was decided to notify the Board 
of Health that a malignant contagious fever prevailed 
in an alarming degree. 

On November 20, 1799, the Governor again asked 
the sentiments of the College as to the " origin and 
nature of the late fever." The College replied that 
they believed the origin and nature were " precisely 
similar" to those of 1793, 1797, and 1798, and that 
the " symptoms and progress all tend to confirm the 
former opinion that it is a pestilential contagious 
disease introduced among us by shipping," reiterating 
also its belief that the Board of Health should consist 
of persons familiar with the disease, because of the 
importance of its early recognition, since whatever 
the differences of opinion among physicians as to its 
origin, they have generally agreed as to the presence 
of the fever very soon after its appearance. The 
College insisted that the first step essential was the 
separation of the sick from the healthy; that quaran- 
tine should begin the first day of May and no ship be 
permitted to ascend the river until October 1. 

In 1802 the fever broke out again in the neighbor- 
hood of Vine and Front Streets, and at a special meet- 
ing of the College, held July 16, it was decided that 
the best way to cut it short would be by an immediate 
separation of the sick from the healthy and the 
general suspension of intercourse with the infected 
houses. The College memorialized the Legislature 
to the same effect, and urged the same measures to 
prevent the spread of the disease. The same views 
were expressed three years later, in 1805, when the 
disease broke out in the neighborhood of Catherine 
and Water Streets. 

In 1805 the College published "Additional Facts 
and Observations Relative to the Nature and Origin 
of the Pestilential Fever." (By the College of Physi- 



278 SELECTED ADDRESSES 

cians of Philadelphia, pp. 99. Printed by A. Bartram 
for Thomas Dobson, at the Stonehouse, No. 41 South 
Second Street, Philadelphia, 1806.) Thus, the fever 
prevailed, with intermissions and remissions, from 1793 
to 1798, culminating the latter year, but no summer 
was free from it until 1806. Two founders died of it, 
Hutchinson, September, 1793, and John Morris, 
September, 1798, and later, Hugh Hodge and William 
Annan, and many more, including Rush, Parke, 
Griffitts, and Kuhn, were very ill. As many as ten 
physicians died in a month, and at one time only 
three were able to do duty outside their own houses. 
Fortunately, some had become immune by previous 
infection. 

In the summer of 1820 there occurred the last out- 
break of j^ellow fever which visited Philadelphia. The 
cases occurred in the usual localities along the Dela- 
ware and were very malignant. The College reiterated 
its views as to its treatment and elimination. 

In July, 1805, Dr. Redman resigned, and in the 
same month Dr. Shippen was elected to succeed him' 
Soon after this came a period of inactivity and indiffer- 
ence which contrasted strongly with the first eighteen 
years of the life of the College. An average attend- 
ance of 12.2, in 1788, fell to 6.7 in 1806, and to 5.9 
in 1812. This average, although numerically small, 
was not proportionally as small as it seemed. The 
number of Fellows did not increase rapidly. In 
1787 there were 24 founders. During twenty years 
between that date and 1807, 22 were added, 3 for- 
feited fellowship, 3 resigned, 6 died, leaving 34, or 
only 10 more than at its foundation, whence it is 
plain that about one-fifth attended the stated and 
special meetings. The slowness of the growth of the 
College was due partly to its high ideals, but it is to 
be remembered also that the number of physicians 



DEDICATION ADDRESS 279 

in Philadelphia at that time was not large. It was 
thought there were about forty-six in the city when the 
College was organized, with some others in the adjoin- 
ing districts. It is to be remembered, too, that there 
was strenuous rivalry. The American Medical Society, 
founded in 1773, was very active, and included among 
its members many Fellows of the College of Physicians, 
some of whom have been mentioned. It held weekly 
meetings from November to February. The Phila- 
delphia Medical Society, the second of that name, and 
organized in 1789, was equally active holding weekly 
meetings. The Chemical Society, instituted 1792, 
included some physicians, and the Philosophical 
Society a larger number. 

Finally, in 1798, was organized the American 
Academy of Medicine of Philadelphia, by Dr. Rush 
and his friends, including a number of distinguished 
physicians who never joined the College, probably 
because of the influence of Dr. Rush. Dr. Physick 
was one of these. Dr. John Redman Coxe the friend 
of Jenner and exponent of vaccination in Philadelphia 
was another. It is said to have been organized with 
a view to the study of yellow fever, but it was also 
in evident opposition to the College of Physicians. 
Dr. Rush writes very quaintly of this society to Dr. 
Alexander under date of February 26: "I have passed 
this far a busy and laborious winter. By business 
has consisted in making additions to my lectures, in 
attending the hospital and many private patients, and 
in assisting in the forming of a new Medical Society 
called the Academy of Medicine. This institution 
will flourish. Dr. Physick is our president, Dr. Cald- 
well is senior vice-president, and our first publication 
will appear in a few weeks. It will contain the proofs 
of the domestic origin of yellow fever, lately presented 
to the government of Pennsylvania, together with 



280 SELECTED ADDRESSES 

some remarks on the report of the College of Phy- 
sicians upon the same subject. The mint employs a 
few moments only of my time three or four times a 
week/' etc., etc. 

The Academy proved to be a short-lived association, 
the last meeting of which there is record being Feb- 
ruary 11, 1799, when officers were elected for the 
ensuing year. 

The Medical Lyceum of Philadelphia, which was 
organized in 1804 and continued until 1819, must 
also during this time have influenced to a degree the 
membership and attendance on the College. 



Ill 



FROM 1808 TO THE CENTENNIAL CELEBRA- 
TION IN 1887 

Dr. Shippen died in July, 1808, and Dr. Adam Kuhn 
was elected to succeed him, September, 1808, being 
the third president. Dr. Kuhn died July 5, 1817 
and was succeeded by Dr. Thomas Parke, July 7, 
1818. At this time, thirty-one years after its founda- 
tion, the roll of the College numbered only eighteen 
Fellows. Dr. Parke was the last one of the founders 
who became president. He occupied the chair for 
seventeen years, until his death in 1835. 

In 1821 the College was pressed for rent, it having 
paid none for over four years. Money was borrowed 
to pay the arrears, but financial stress continued 
through 1822 and 1823. In 1829, for the first time, 
the Censors reported a respectable balance of $109.42 
in the treasury. In 1833, in November, the balance 
amounted to $308.42 which was invested, thus furnish- 
ing the first evidence of financial ease noted in forty- 
six years. 



DEDICATION ADDRESS 281 

In 1824 the College intervened for the first time 
with the course of the law in appealing to the Governor 
of the State for respite of execution in the case of 
one John Zimmerman, guilty of murder. The 
Governor requested an examination of the man by a 
committee of the College, which reported him insane. 
The execution did not take place. I am not aware 
that this action has ever been repeated. 

In 1824, the College of Pharmacy of Philadelphia 
represented that there was a reason to believe that 
some physicians were in receipt of a loyalty from 
apothecaries to whom they sent prescriptions, and 
asked the cooperation of the College in breaking up 
the practice. The College replied that none of its 
Fellows had ever degraded themselves by such a 
course, and hoped the College of Pharmacy would be 
able to dissuade its members from the practice. At 
the same time it invited the attention of the College 
of Pharmacy to the practice of prescribing over the 
counter by certain pharmacists. The College of 
Pharmacy appointed a committee to confer with the 
College on this matter, but the latter failed to take 
any part in a conference. 

In 1827 the College apparently became restless over 
its inactivity, and resolved that each Fellow in turn, 
beginning at the head of the list, should at each stated 
meeting read an original or selected paper, which 
should be the subject of discussion, every person 
failing to comply being required to pay the sum of 
$1. Dr. Parke, the president, read the first paper, on 
the use of cold and warm bathing. In 1829, when it 
was his turn to read a paper again, Dr. Parke excused 
himself and paid the fine of $1. 

On September 4, 1827, it was resolved that the 
meetings, which had previously been held in the after- 
noon, should be at seven in the evening from October 



282 SELECTED ADDRESSES 

to March, and at 8 p.m., from April until September, 
and on December 4 the day of the monthly meeting 
was changed from the first Tuesday to the last 
Tuesday. In consequence of the change of hour, the 
rent was increased $6 a year because of the use of can- 
dles. In April, 1852, the day of the stated meeting 
was again changed from Tuesday to Wednesday, be- 
cause of the interference of the College meeting with 
that of the Academy of Natural Sciences. 

In March, 1827, a proposition was made to limit 
the number of Fellows to forty, but this motion did 
not prevail. Later, in 1833, the number of Associates 
was limited to forty, ten of whom were to be foreigners. 
In September, 1839, another effort was informally 
made to limit the fellowship, this time to sixty-five, 
but again failed. At this meeting it was decided that 
candidates for fellowship, instead of applying for 
admission, were to be proposed by three Fellows and 
balloted for at a subsequent meeting. 

In 1832 the College, which had been meeting in the 
Hall of the Philosophical Society since 1791, took the 
first steps toward a change of place of meeting by 
appointing a committee to confer with a committee 
of the Athenaeum on a proposition to erect a building 
for the accommodation of the several societies. This 
effort was unsuccessful. 1 

In 1832, when the cholera invaded the United States, 
the College prepared to meet it energetically, being 
requested April 12, by the Board of Health, to ap- 
point a committee "to institute an impartial examina- 
tion into all the facts in relation to the epidemic 
cholera and to report in detail the result of the in- 
vestigation for the benefit and satisfaction of the un- 

1 1 have given the history of this and other efforts in this direction in 
an address on the "Homes of the College," at the laying of the corner- 
stone of the New Hall, May, 1908. 



DEDICATION ADDRESS 283 

professional as well as the medical part of the com- 
munity." This committee prepared a report, which 
was amended, adopted, and transmitted to the Board 
of Health. In 1835-36 another visitation of cholera 
occurred, and in 1848 another, by way of New Orleans 
and the Mississippi valley, extending as far as Cali- 
fornia. In 1854 another severe epidemic raged through 
the United States, for which immigration was re- 
sponsible. The very serious epidemic in Europe in 
1884 to 1886 again gave rise to apprehension, and in 
November, 1884, a committee was appointed to ad- 
dress Select and Common Council of the city in re- 
gard to proper measures to be taken to avert the 
threatened invasion of cholera the following year. 
A communication from the National Board of Health 
was read and referred to the Committee. On Novem- 
ber 18, 1886, a special meeting of the College was held 
to hear an address on the subject of Asiatic cholera, 
by Dr. E. 0. Shakespeare, who had been appointed 
by the United States government to study the disease 
in Spain. 

In February, 1835, occurred the death of Dr. Parke, 
the president and the last survivor of the Founders. 
He was succeeded by Dr. Thomas C. James, who 
died four months after his election. Dr. Thomas T. 
Hewson was elected July 7, 1835. The year 1837 
completed the first half century of the existence of 
the College. 

In 1839 the College recommended to the Legislature 
the laying out in each district of the city of a public 
square with a fountain in each. Thus arose Wash- 
ington Square, Franklin Square, Rittenhouse Square, 
and Logan Square. The College repeated this course 
May, 1888, urging the immediate dedication of seven 
small parks and future increase of small parks. This 
policy has been continued under the fostering care of 



284 SELECTED ADDRESSES 

the City Parks Association, and numerous small and 
larger parks scattered throughout the city attest its 
beneficent results. In the same line was also action 
by the College in 1843, when it sent to the chairman 
of a committee of the City Councils in charge of the 
matter a preamble and resolution recommending the 
purchase of Lemon Hill, with a view to the preserva- 
tion of the purity of the water supplied to the city 
from the Schuylkill. 

As amended in 1834, the by-laws provided a com- 
mittee of three Fellows on Library and seven stand- 
ing committees, as follows: 

(1) Theory and Practice of Medicine; (2) Surgery; 
(3) Mid-wifery; (4) Diseases of Children; (5) Materia 
Medica and Pharmacy ; (6) Meteorology and Epidemics ; 
(7) Public Hygiene. 

It became the duty of the president or vice-presi- 
dent, at the stated meeting in August of every year, 
to assign each Fellow to one or other of these com- 
mittees. Each committee was required to submit an 
annual report at stated times. It was the duty of 
the library committee to purchase books and have the 
care of the library as well as of papers confided to it 
by the College. As the number of Fellows increased, 
the working of the committees became cumbersome, 
and the by-laws were amended June, 1840, so as to 
require the president to appoint in June, besides a 
Committee on Library, one of the Fellows to report 
annually on each of the above-named subjects, to 
which was added Diseases of Women. The committees 
were more or less active for sixteen years, until 
January, 1851, when all except the Committee on 
Library and on Meteorology and Epidemics were dis- 
continued. The annual reports made by the last 
committee were published in the Transactions of 
the College until 1884, when they were discontinued. 



DEDICATION ADDRESS 285 

From July 1, 1845, to 1852, the College meetings 
were held in the Mercantile Library; from 1852 to 
1863, in the "picture house" at the Pennsylvania 
Hospital. In 1863 it occupied the then new Hall at 
Thirteenth and Locust Streets. 

The College evidently looked askance upon the 
first effort to organize the American Medical Associa- 
tion. In 1845, a letter was received from the New 
York State Medical Society to the effect that a 
national medical convention, consisting of delegates 
from the medical institutions of the United States, 
would be held in the city of New York May 1, 1846, 
and a letter was received from Dr. N. S. Davis, re- 
questing that delegates be appointed to represent the 
College. The matter was referred to a committee, of 
which Dr. George B. Wood was chairman, on whose 
report the College resolved that while it cordially 
approved of the proposed object, it did not, under 
existing circumstances, deem it expedient to appoint 
delegates to represent it in the convention. 

Dr. Thomas T. Hewson, president, died February 
17, 1848, and was succeeded by Dr. George B. Wood, 
March 7, the same year. 

The year 1849 was noteworthy in the history of the 
College from the fact that there was started the 
building fund by which the College was enabled to 
construct the Hall it has just left, and by the initiation 
of effort to provide a pathological museum. The 
steps in the collection of funds with which to construct 
the new Hall are ably represented by Dr. Ruschen- 
berger in his history of the " Institution of the College/ ' 
and the reader is referred to it. 1 

The first motion in the direction of a pathological 

1 See Centennial Volume of Transactions of the College for 1SS7: 
also separate reprint of Dr. Ruschenberger's, "An Account of the 
College of Physicians of Philadelphia, 1887. 



286 SELECTED ADDRESSES 

museum was in June, 1849, by Dr. Isaac Parish. The 
by-laws were altered to provide as officers of the 
College a Curator and a Committee on the Museum. 
John Xeill was the first curator elected October, 
1849. The nucleus of the Museum was a collection 
of specimens made by Dr. Joseph Parrish. For its 
day the Museum grew rapidly, but it was not until 
it received the generous gift of the museum of Dr. 
Thomas Dent Mutter, along with an endowment of 
830,000, that it became an important feature of the 
College. An idea of the value of Mutter's museum 
may be formed from the fact that Dr. Mutter had 
been offered S2 0,000 for it, that he had spent more 
than as much on it, besides much valuable time and 
labor. 

One of the conditions of the gift of Dr. Mutter was 
the housing of the Museum in a fireproof building. 
This was rendered possible in the completion of the 
new building at Thirteenth and Locust streets, but 
occasioned some delay before all interests concerned 
were satisfied. By January 6, 1864, however, all 
preparations were completed and the Museum trans- 
ferred to the College and arranged. It then consisted 
of 1139 specimens, 300 casts, 48 oil paintings, and 
364 water-color drawings. The associated endow- 
ment provided not only for the care and insurance of 
the Museum, but also a salary of $300 a year for the 
curator, and $200 a year for a lecturer. Besides the 
additions by natural growth, it has acquired by 
purchase from time to time several valuable collec- 
tions, including the Hyrtl collection, the Pollitzer 
collection, and in 1867 that of Dr. Walter F. Atlee. 
The collection of slides by Dr. Schmidt, of Xew Or- 
leans, illustrating tuberculosis, was purchased in 
1889, and in April, 1889, Dr. Henry C. Chapman 
presented a collection of entozoa. The purchase of 



DEDICATION ADDRESS 287 

books bearing on pathology was decided to be within 
the province of the committee on the Mutter Museum, 
and some valuable works have been thus obtained. 

The first publication of the College may be said to 
the proclamation published in the Pennsylvania Packet 
and Daily Advertiser, of February 1, 1787, to the effect 
that the College of Physicians had been founded, add- 
ing the constitution and list of the members. The 
second was a eulogium on Dr. Cullen by Dr. Rush, 
July 19, 1790. Dr. Cullen had been the professor 
of the Practice of Physic in the University of Edin- 
burgh and the teacher of many of the founders when 
they were students at the University of Edinburgh. 
Hence their warm attachment and profound respect 
for him. 

The first committee which might be called a publi- 
cation committee was appointed in May, 1793. It 
consisted of Andrew Ross, Caspar Wistar, Samuel 
P. [Griffitts, Michael Leib, William Currie, John 
H. Gibbons, ! Benj. Rush, and William Shippen, Jr. 
Under its supervision was published the first volume 
of Transactions. The first three were to prepare 
the "copy," the second three to superintend publica- 
tion, and Drs. Rush, Shippen, and Griffitts were to 
write a preface to the volume. 

The first part of Volume I, containing among other 
papers an address by Rush "On the Objects of the 
Institution," was reported as ready for distribution 
August 26, 1793. The printing committee was di- 
rected to send a copy to the author of each paper in 
the volume, and to the medical societies of the United 
States and Europe, the beginning of our system of 
exchange, which is one of the largest and most com- 
plete possessed by any library. A pamphlet entitled 
Proceedings of the College of Physicians of Philadelphia 
Relative to the Prevention, Introduction, and Spreading 



288 SELECTED ADDRESSES 

of Contagious Disease was published in 1798. Another, 
entitled Facts and Observations on the Nature and 
Origin of the Pestilential Fever which Prevailed in 
1793, 1797, and 1798, was issued in 1800, and a third, 
entitled Additional Facts and Observations Relative 
to the Nature and Origin of the Pestilential Fever, by 
the College of Physicians, was published in 1806. 
Dr. Wistar's "Eulogium on Dr. Shippen" was 
delivered in 1809 and published by the College in 
1818. 

After a period of inactivity extending over several 
years, measures were adopted in October, 1841, to 
publish quarterly a summary of the Transactions, 
and a publication committee was appointed. Between 
1841 and 1850 three volumes were thus issued under 
the direction of the Committee on Publication. 
Agreement was made with a firm of publishers to 
print and sell the work, and a new series of the 
summary of the Transactions was begun in 1850, 
and continued to the end of 1857. Then, to save 
expense, an arrangement was made with the pro- 
prietor and editor of the American Journal of the 
Medical Sciences to publish, free of cost, the written 
and verbal communications and the abstracts of 
discussions, and to supply a sufficient number of 
extra copies for the use of the College. Under this 
arrangement a new series was started and continued 
until the completion of the fourth volume, in 1874. 

In the latter year the contract with the American 
Journal of the Medical Sciences was annulled and the 
College resumed the publication of its Transactions. 
The first volume of this, the third series, was published 
in 1875, and the thirtieth in 1908. In 1885 the pub- 
lication committee was $822.33 in debt, and, in view 
of the desperate situation, a proposition to accept an 
offer of the Medical Times to publish the Trans ac- 



DEDICATION ADDRESS 289 

tions without expense to the College was considered, 
but through the generosity of Dr. Da Costa, who was 
then president, the debt was paid and the publication 
continued by the College itself. 

Between 1864 and 1887 the life of the College 
was not signalized by striking events. Dr. Rus- 
chenberger succeeded Dr. Wood as president in 1879. * 
Dr. Stille followed Dr. Ruschenberger in 1883, and 
Dr. Samuel Lewis served for a short time in 1884, 
resigning on account of ill health. Dr. J. M. Da 
Costa was chosen for the unexpired term and reelected 
in 1885. Dr. Mitchell was elected in January, 1886, 
and again in 1887 and 1888. 

The library and museum both grew rapidly, and 
it was evident that more space would be required for 
both before long. This stimulated the Fellows to 
prepare for such requirement, and on January 6, 
1875, a committee was appointed to devise a plan for 
collecting a building fund, which was called the 
" building extension fund." The committee reported 
April 7, 1875, proposing that all entrance fees and any 
surplus which the College could afford should be appro- 
priated to this fund, and that subscriptions, donations, 
and legacies to it should be encouraged. This was 
adopted. On December 1, 1875, $400 was transferred 
from the treasury of the College to the fund, and on 
March 3, 1883, Dr. Da Costa gave the first personal 
subscription of $1000; and a committee was appointed 
to solicit further contributions. This fund grew 
rapidly, and in the course of a few years became 
sufficient to enable the College to complete the third 
story of the Hall, providing, it was thought, for the 
growth of the museum and library for many years to 

1 This year it was enacted that no Fellow shall be eligible to the 
office of president more than five years in succession, and in 18S2 
tenure of office was limited to three years. 

19 






290 SELECTED ADDRESSES 

come. The extension was begun May 27, 1885, 
and finished May 31, 1886. 

The Mutter lectureship gave much concern. By 
the terms of the bequest, once in three years a lecturer 
was to be appointed who should give a course of not 
less than ten lectures each year on some subject con- 
nected with surgical pathology. Dr. John H. Packard 
was the first lecturer, and gave a course upon " Inflam- 
mation/ ' in accordance with the conditions, but after 
him it was found difficult to secure competent lecturers. 
Several partial courses were given, and some ap- 
pointed resigned before giving a single lecture. By 
agreement with the executors of Dr. Mutter's will, 
modifications were made in the conditions which 
permitted the delivery of one course of lectures trien- 
nially, and that the lecturer should receive the whole 
compensation for three years. In this way several 
more courses were secured, eight courses of ten lectures 
in all, but even this arrangement fell through sub- 
sequently, and at present, by resolution, June, 1901, 
it was made an annual lectureship, the remuneration 
to be $200. 

The year 1882 was characterized by the establish- 
ment of a directory or bureau of registration for nurses. 
While such a function might at first be thought 
beneath the dignity of a medical society of the impor- 
tance of the College, a moment's reflection must con- 
vince one that the purpose is legitimate and directly 
in a line with the treatment of disease and alleviation 
of suffering. On the other hand, there can be no 
doubt that the importance and dignity of the College 
gave at once a character and respectability to the 
movement which did much to secure its immediate 
success. Organized in 1882 by a committee of 
the College, aided by a number of influential women 
of the city headed by Mrs. Weir Mitchell, the Direc- 



DEDICATION ADDRESS 291 

tory is continued under the management of this 
committee, known as the Committee on the, Directory 
for Nurses. Its members are annually elected, and it 
is assisted by four ladies selected by the committee. 
The Directory has not only been of serivce to the 
community in supplying promptly efficient nurses 
from those registered, but it has also aided the latter 
in securing employment, and has paid into the treasury 
of the College many thousands of dollars which have 
been devoted to increasing the library. 



IV 



THE CENTENNIAL CELEBRATION AND 

SINCE 

The College in its infancy and for some time 
afterward was very poor. It was often in arrears 
with its rent, and once had left it unpaid for four years. 
On this account social entertainment attracted little 
attention until November, 1877, when the Council 
was directed to consider whether it was advisable for 
the President to give an annual reception at the 
expense of the College. The Council reported that 
the state of the treasury alone rendered such a course 
inexpedient. In February, 1883, Dr. Weir Mitchell 
presented $5000, subsequently increased to $7000, to 
establish an entertainment fund. This generous gift 
and its purpose was followed by the appointment of 
an entertainment committee, which has been called 
upon to exercise its function on several occasions. 
The first was a reception given to the medical members 
of the American and British Associations for the 
Advancement of Science, September 8, 1884. Under 
the direction of the committee a dinner was given 
by the College, April 14, 1886, at which a loving cup, 



292 SELECTED ADDRESSES 

presented by Mrs. Weir Mitchell, was used for the 
first time. A reception to the State Medical Society- 
followed in June, 1888, since which the Fellows have 
dined together in their own Hall several times. 

Thus we approach the most important event in the 
history of the College after its organization, namely, 
the Centennial Anniversary, celebrated Monday and 
Tuesday, January 3 and 4, 1887. The celebration 
may be said to have commenced with the arrival of 
invited guests on Sunday, January 2, the actual 
anniversary. The day was bitterly cold, and is 
especially associated in my mind with the presence of 
that gentle and accomplished physician, R. Palmer 
Howard, then Professor of Medicine in McGill College, 
Montreal, who was my guest and whom I took in 
the afternoon to old St. Peter's church on Pine Street, 
where lies buried John Morgan, one of our most bril- 
liant and accomplished founders, so that a visit to 
the church seemed natural and appropriate. In the 
evening our guests were entertained at tea and social 
visits were exchanged. 

On the next morning the ground was covered with 
snow, so that Philadelphia appeared clad in gala dress 
for the occasion. In the evening there were dinners 
to our guests at the homes of the Fellows, and at 
7.30, at Association Hall, a commemorative address 
by our beloved president, Dr. Weir Mitchell, who 
reviewed the lives of the founders and of some of their 
predecessors, bringing out the traits and characteristics 
of each. I know of no better short sketches of these 
worthies than those then read by Dr. Mitchell. 
Following the address was a general reception to the 
public and Fellows at the Hall of the College, where 
was also displayed a loan collection of portraits of 
eminent physicians and rare objects of professional 
interest. 



DEDICATION ADDRESS 293 

On Tuesday, January 4, the second day, a special 
meeting of the College was held at noon, when Prof. 
Alfred Stille delivered an address entitled '" Reminis- 
cences of the College," but which in connection with 
the commemorative address of Dr. Mitchell, con- 
stitutes a good condensed history of the College from 
its foundation to the centennial celebration. On 
the same occasion certificates of associate fellowship 
were presented by the President to eleven eminent 
confreres from different sections of the country. Each 
presentation was preceded by appropriate remarks 
referring to the special attainments of the proposed 
Fellow. Then followed an address of welcome to the 
new Associates, by Professor J. M. Da Costa, and 
succeeding this a luncheon. Alas! all except two of 
the associates have gone to their long homes. All are 
names over which we who knew them love to linger. 
They are Robert Palmer Howard, of Montreal; 
William H. Draper, of New York; George Cheyne 
Shattuck, of Boston; Nicholas Senn, of Chicago; T. 
Gaillard Thomas, of New York; James T. Whittaker, 
of Cincinnati; David W. Yandell, of Louisville, Ken- 
tucky; John C. Reeve, of Dayton, Ohio, and Hunter 
McGuire, of Richmond, Virginia. Only Dr. Cheever 
and Dr. Bowditch remain. 

In the evening 120 Fellows, Associates, and guests 
of the College sat down to dinner in the banqueting 
hall of the Union League. There were toasts and 
appropriate verses, and the loving cup was passed 
amid much rejoicing and congratulation that the 
College had rounded its first century under such 
favorable circumstances. Death, too, has dealt 
harshly with those of the company who spoke at the 
dinner. Agnew, who replied to the toast "The Fellows 
of the College/ ' Gaillard Thomas, who spoke for the 
" Associate Fellows," William Pepper, who replied for 



294 SELECTED ADDRESSES 

"The Physician," Ashhurst, for "The Surgeon," 
Parvin, for "The Obstetrician," George Cheyne 
Shattuck, an Associate and the son, and father, of 
an Associate, who toasted "The College of Physicians," 
and Henry Hartshorne, who read a poem entitled, 
"The Old and the New Physic," have all gone. Only 
Billings, who spoke for "The Medical Societies of 
America," and Mitchell, who read "Commemorative 
Verses," survive. 

The occasion also marked the completion of the 
then new College Hall at Thirteenth and Locust Streets, 
by the addition of the third story at a total cost of 
$67,256.50, including the site, which cost $14,408. 
This sum, even so late as 1887, was thought to be very 
large, and the then new Hall was put in strong contrast 
with the modest room in Fourth Street where the first 
meeting was held one hundred years earlier. Speaking 
of the trustees of the building fund as constituted in 
1849, when a small sum in the treasury of the College 
was devoted to this purpose, Dr. Stille" said, in his 
centennial reminiscences, "To their wise and prudent 
management we owe the foundation, and much more 
than the foundation, of the great building in which we 
are this day assembled." Yet the total investment 
is insignificant as compared with what has been 
expended for this, our latest home, appointed as no 
building for a like purpose ever was. Short as has 
been the interval since our centennial celebration, I 
do not believe that our seniors of the latter day had 
any better idea of the changes a quarter of a century 
would bring about than had Morgan, Shippen, Kuhn, 
and Rush, in their day, of the possibilities of the 
coming century. 

The College of Physicians did not die with the 
centennial celebration. Its work stands out less con- 
spicuously in some respects than in the old days 



DEDICATION ADDRESS 295 

because it is now one of many instead of a few societies 
existing for many years after its foundation. Less 
frequently called upon to express its opinion and 
render aid to the city, State, and nation, it has never- 
theless continued its suggestions and criticisms when 
they seemed opportune, and they have been generally 
received with consideration and respect, while the 
College has been of infinite service in extending the 
treasures of its library to the thousands of physicians 
and students whose researches and writings would 
have been impossible without its help. 

One of the most important functions of the College 
developed in this period is the stand it has taken 
against encroachment on the right to use, humanely, 
animals for investigating the action of medicines and 
determining the causes, prevention, and cure of 
disease. As early as February, 1885, the College 
memorialized the Legislature on the " antivivisection 
bill" which was before that body. Its efforts were 
successful in preventing the passage of the bill. In 
April, 1886, a committee was appointed charged with 
the protection of the right of scientific research, with 
Dr. H. C. Wood as chairman. The vigilance of this 
committee was exercised for some time in behalf of 
the interest of science, and although it is no longer 
maintained, its work has been continued by resolution, 
memorial, or the acts of specially appointed com- 
mittees. Almost every biennial session of the Legisla- 
ture has called for efforts in the direction of its pur- 
poses, and they have all been successful. The College 
also petitioned the national government, when several 
years ago legislation against experimental medicine 
was attempted but thwarted. 

The same broad humanitarian purpose was shown 
in its approval, by resolution, February, 1887, of the 
action of the United States Senate in appropriating 



296 SELECTED ADDRESSES 

$10,000 toward the expenses of investigating the 
etiology of yellow fever in South and Central America. 
In line with this action was a resolution of the College, 
January, 1893, urging the passage of a bill by Congress, 
allowing the widow of Dr. Walter Reed, who fell a 
victim to his zeal in the study of the cause of yellow 
fever, a pension of $4000 a year. Also a resolution, 
January, 1903, asking the President of the United 
States to grant the amplest authority to the medical 
officers in charge of the sanitation of the Isthmathian 
Canal construction, and urging that a medical officer 
be made a member of the Commission, to be appointed 
by the President to conduct the affairs of the proposed 
canal. Whatever may have been the influence of the 
College in securing such appointment, the action has 
been more than justified by the brilliant and satis- 
factory results obtained by our Associate Fellow, Dr. 
Wm. C. Gorgas, in the administration of his duties as 
sanitary officer. 

The subject of quarantine has at all times received 
the interested attention of the College, beginning with 
the efforts in this direction when the city was battling 
with the yellow fever from 1793 to 1798. Unfortu- 
nately, diverse interests as well as the changing and 
antagonistic views of those claiming special knowledge 
on this subject have often rendered efforts nugatory. 
These unsatisfactory results have been further favored 
until lately, and to some extent at the present time, 
by our ignorance of the precise causes of certain in- 
fectious diseases. After yellow fever, cholera claimed 
attention, first in 1832, and later, in October, 1887, 
when a committee was appointed to secure concerted 
action on the part of the medical societies of the land 
in obtaining a uniform and efficient system of national 
quarantine against contagious diseases, and especially 
against cholera, for all exposed ports. 



DEDICATION ADDRESS 297 

In December of the same year a special meeting 
was held to consider the address of the committee 
on Cholera above referred to. The address was 
approved and ordered sent to these societies. In 
February, 1893, resolutions were adopted advocating 
international quarantine in all frontiers and the 
establishment of a national department of health, 
which were forwarded to the Congress of the United 
States. 

In May, 1893, a quarantine board was created by 
the Legislature of the State of Pennsylvania for the 
administration of State quarantine on the Delaware 
River, providing also for representation of the College. 
The president appointed to this service our Fellow, 
Dr. Richard A. Cleemann, who continues to discharge 
it to the satisfaction of the College. 

April, 1888, the College continued its role of pro- 
tector of public safety by passing a resolution protest- 
ing against the use of water gas as a mixture with 
coal gas for illuminating purposes in greater propor- 
tions than 10 per cent. In May a letter was received 
from the Mayor promising to give careful attention 
to this request. Apparently this promise was in- 
effectual, for many lives are sacrificed annually by this 
agent. 

The College has always been ready to render, to 
the extent of its ability, aid to members of the pro- 
fession who have suffered in public calamity. Ac- 
cordingly, in June, 1889, at a special meeting, a com- 
mittee was appointed to act in cooperation with one 
from the Philadelphia County Medical Society for 
the relief of the sufferers, and especially medical 
sufferers, by the Johnstown flood. Response was 
liberal in money and in personal service by volunteers, 
who hurried to the scene of the disaster. In May, 
1906, the College cooperated with the County Medical 



298 SELECTED ADDRESSES 

Society in similar efforts for the immediate relief of 
the physicians of San Francisco succeeding the earth- 
quake. In June it was ordered that duplicate volumes 
from our library be presented to San Francisco medical 
libraries at the discretion of the library committee. 

The College has never taken a very active part in 
influencing medical education, though an interesting 
event in its early history may be mentioned in this 
connection. At a special meeting as early as March 
10, 1794, it was announced that the chairman of a 
committee of the House of Representatives, charged 
with the preparation of a bill a to regulate the prac- 
tice of physic within the State," had asked the assist- 
ance of the College. Accordingly the College recom- 
mended, March 14, that, excepting graduates of the 
University, all applicants for license to practise within 
the State should be examined by persons appointed 
by the College for this purpose, under penalty for 
non-compliance; also that apothecaries should be 
examined for license. A bill embodying this and other 
provisions was introduced into the Legislature a 
couple of weeks later, March 24, 1794, but it was laid 
on the table; and although a motion to bring it up on 
second reading, Monday, March 31, prevailed, it 
was not read, and no further reference to it has been 
found. 

In February, 1891, a committee was appointed to 
represent the College before the Legislature in ad- 
vocacy of a bill to establish a State Board of Medical 
Examiners and Licensers, and in opposing a bill pro- 
viding a State Board of Medical Education. The 
bill establishing a State Board of Medical Examiners 
was passed, and has been of great service in advancing 
the standard of medical education. 

In January, 1892, Dr. Mitchell was again elected 



DEDICATION ADDRESS 299 

president, succeeding Dr. Agnew, and reelected in 
1893 and 1894. 

In 1893 the College, desiring to increase the oppor- 
tunity for the reading of papers often encroached upon 
at the monthly meetings by a pressure of business, 
voted to establish sections representing the different 
branches of medicine, to meet as often as deemed 
necessary, in addition to the stated monthly meetings 
of the College. Under this resolution were formed 
sections on surgery, orthopedic surgery, ophthal- 
mology, otology and laryngology, gynecology, general 
medicine, and medical history. They have' been 
variously successful, that on ophthalmology especially 
so. The same is true of otology and laryngology. 
That on general medicine is not as successful as it 
should be; due in part to the fact that there are many 
other society meetings at which medical papers and 
reports of cases are read. The sections on surgery, 
orthopedic surgery, and gynecology have been dis- 
continued. 

In January, 1895, Dr. Da Costa was reelected presi- 
dent, at the end of Dr. Mitchell's second administra- 
tion of three years, and reelected in 1896 and 1897. 

In January, 1898, Dr. John Ashhurst became presi- 
dent, and was reelected in 1899. 

In January, 1900, Dr. W. W. Keen was chosen 
president, and reelected 1901. Dr. Keen's adminis- 
tration was characterized by unusual success in in- 
creasing the endowment and growth of the library. 
An additional endowment of $50,000, largely through 
Dr. Keen's personal efforts, was secured. 

In January, 1902, Dr. Mitchell announced from 
Mr. Andrew Carnegie the gift of $50,000 toward the 
construction of a new hall, conditioned on a like sum 
being raised by subscription. 

Dr. H. C. Wood became president in January, 1902, 



300 SELECTED ADDRESSES 

and was reelected 1903. His administration was 
characterized by the initiation of active measures 
toward meeting the demand for increased space to 
accommodate the rapidly growing library, and at a 
special meeting held January 21, 1903, he exhibited 
plans of alteration and enlargement of the old Hall, 
as we shall now call it. At the same meeting a com- 
mittee was appointed to consider plans. From this 
time forward were announced numerous contributions 
to the building fund, and Mr. Carnegie's conditions 
were soon met. 

Dr. Arthur V. Meigs was elected president in 1904, 
and reelected in 1905 and 1906. 1 His administration 
was characterized by much activity in the settlement 
of the question of removal to a new site for the 
proposed new Hall. 

In May, 1903, the question of removal and the 
securing of an option on certain lots was referred to 
a committee, which at a special meeting, held May 29, 

1 It was on April 6, 1904, that the College adopted a resolution to 
the effect "that a Building Committee of Six (6) be appointed, to 
consist of the President, who shall be the chairman, and five other 
Fellows appointed by him." 

Under this resolution the committee included: 

The President, Dr. A. V. Meigs, Chairman, 
Dr. James Tyson, Dr. William Thomson, 

Dr. J. C. Wilson, Dr. William J. Taylor, 

Dr. George McClellan. 

On May 4, 1904, the College voted that an additional member of 
the committee be appointed by the President, and Dr. J. K. Mitchell 
was appointed. 

Dr. Meigs' term as President expired at the January meeting, 1907, 
leaving a vacancy which was filled, on February 6, 1907, by the ap- 
pointment of the Vice-president, Dr. G. E. de Schweinitz, by the 
President (Dr. Tyson). 

On April 3, 1907, the Treasurer, Dr. R. H. Harte, was added to 
the committee. 

Dr. Thomson died on August 3, 1907, and Dr. F. P. Henry was 
appointed in his place. 



DEDICATION ADDRESS 301 

recommended the purchase of a lot on Twenty-second 
Street below Chestnut, for $80,000. This was author- 
ized. In November a committee on plans was ap- 
pointed, which reported April 6, 1904, and was then 
replaced by a building committee, under which, with 
additions, the new Hall we now inaugurate has been 
constructed. 

At a special meeting, March 30, it was decided to 
remove to the Twenty-second Street lot. In May, 
1906, the College, having in the meantime heard the 
report of a minority committee opposed to removal, 
and having been in negotiation for several lots rejected 
for various reasons, reaffirmed its intention of erecting 
a new Hall on Twenty-second Street, and the building 
committee was directed to proceed with the duty 
assigned to it in the matter of plans and estimates 
to be presented at the October meeting. Stewardson 
& Jamison were selected architects, ground was broken 
January 30, 1908, and the corner-stone was laid with 
suitable cermonies April 29, 1908. 1 It is finished 
today, November 10, 1909. 

Having considered some of the important events in 
the history of the College, I may be permitted, in 
conclusion, to select a few links from the chain of 
events which bind the past to the present and which 
have more or less shaped its course and determined its 
auspicious present: First, a foundation following the 
example of the best type of the English medical 
society; second, founders, twenty-four in number, 
most of them trained in the best medical schools in 
Europe, succeeding the best obtainable education at 
home; third, experience either in the field or practice 
at home during an eight years' war characterized by 
privation and hardship which broadened the knowl- 

1 See Transactions of the College, third series, vol. xxx, appendix. 



302 SELECTED ADDRESSES 

edge, increased the skill, and developed the character 
of those concerned in it; fourth, a baptism of pestilence 
and death, which, by the difficult problems it raised, 
disrupted friendships and endangered the existence 
of the College itself; fifth, through patience of surviv- 
ing founders and other members added, with the lapse 
of time, a revival of life, a new growth of strength, and 
development of service until through its various 
functions the College has become a great power for 
the increase and dissemination of medical knowledge 
and for inspiring the higher aims of the medical 
life. 

At the time the College was founded medical 
science was overweighted with theory, and the theo- 
ries of Stahl, of Hoffman, of Boerhaave, of Curren, of 
Brown, of Brussais and others were much discussed, 
with the usual vapid results of theoretical speculation, 
and it is perhaps fortunate that opportunities for 
writing were limited by distance from what were con- 
sidered the fountain heads of medical learning of that 
day, and by the difficulties which surrounded printing 
and book making in general. It is on this account, 
perhaps, that our earlier Transactions, though not 
copious, were of a more practical character than those 
of the societies of other English-speaking communities 
of the day, comparing well with such Transactions and 
those of other foreign countries. 

It is gratifying also to note from the biographical 
sketches of our founders and their immediate succes- 
sors that pecuniary emolument played a minor role 
as a motive in their practice, that personal danger was 
ignored, that relief to the suffering of their fellow 
citizens was their first aim, that they lived, in a word, 
up to the motto of the College: 



DEDICATION ADDRESS 303 

NON SIBI SED TOTI 
NOT FOR ONE'S SELF BUT FOR ALL 



THE LIBRARY 

As early as June 3, 1788, a committee was appointed 
to report a plan for the formation of a library, whose 
report was laid on the table July 1. On August 5, 
however, it was resolved "that the several members 
of the College be requested to send to the secretary 
such books as they were willing to present to the 
College.' ' Dr. John Morgan was the first liberal 
respondent, presenting twenty-four volumes in Decem- 
ber, 1788, and others in January, 1789. On March 3, 
1789, the same committee reported a plan of collect- 
ing, buying, storing, and lending the books, which was 
adopted. Almost immediately the growth of the 
library, when the day and times are considered, was 
phenomenally rapid. Among the other early liberal 
contributors were Dr. William Shippen, Dr. John 
Morris, Dr. John Jones, Dr. Benjamin Rush, and 
Dr. Parke. The first catalogue was completed 
January 5, 1819, after some books were found missing. 
For a time after this the growth of the library was 
slow, and in 1836 there were only 291 volumes in 
addition to a number of unbound pamphlets. In 
1834 a standing committee on the library was created, 
the chairman of which was regarded as librarian, and 
the office of librarian was not created until 1854. 
In 1835 a committee reported the library in bad 
condition, and was instructed to take steps for its 
preservation. Between 1819 and 1843 very few 
volumes were added, and the books were rarely used. 



304 SELECTED ADDRESSES 

Succeeding 1843 the growth became more rapid, 
culminating, in 1858, in a gift of 1265 volumes from Dr. 
Thomas F. Betton, including many rare and important 
works. In May, 1859, the library was ordered open 
one evening in the week. In December it contained 
4000 volumes, besides pamphlets and theses. 

But the real growth of the library began with the 
the munificent gifts of Dr. Samuel Lewis, the first of 
which was made in February, 1864, when he gave 
more than 2500 volumes through the chairman of the 
Library Committee, Dr. Alfred Stille. This gift be- 
came the nucleus of the Lewis Library, which con- 
tained at the end of 1909, 13,536 volumes. 

On March 4, 1868, was started the Library Fund by 
a donation of $445.90 from the Philadelphia Medical 
Society, increased by the College to $500 and ordered 
invested. At his death, in 1879, Dr. George B. Wood 
gave $7581 to the Library for purposes other than the 
purchase of books. In November, 1880, Dr. S. Weir 
Mitchell gave the first $1000 toward the Library 
fund, which he subsequently increased to $5000. 
In 1871 a journal club was formed, which annually 
contributes to the Library sixteen periodicals. 

A card catalogue was commenced in 1881 by Miss 
Emily Thomas. In 1884 Dr. Alfred Stille* gave 695 
volumes. In April, 1884, the S. D. Gross Library 
(5128 volumes) of the Academy of Surgery was de- 
posited, with the understanding that it should be- 
come the property of the College when the Academy 
should be dissolved. In the same year was deposited 
the library of the late Dr. H. Lenox Hodge, known as 
the Hodge Collection, and later became the property 
of the College as a gift from his son. In 1886 Dr. I. 
Minis Hays presented 901 volumes, and Mr. George 
I. McKelway 166 volumes. In 1886, also, Mrs. J. 
F. Weightman presented 512 volumes to the library, of 



DEDICATION ADDRESS 305 

which 351 were new and dealt chiefly with ophthal- 
mology. In 1887 Mr. William Weightman gave 
$1000, the interest of which was to purchase books on 
ophthalmic surgery, to be added to the collection 
given by the widow of Dr. Weightman. 

In 1886 the John S. Parry library and the library of 
the Obstetrical Society were contributed. In 1887 
the library of Dr. Archer N. Randolph, 466 volumes, 
was presented to the College. In 1887, by sale of 
duplicates and special books belonging to the S. D. 
Gross Library and the general library, $786.65 was 
raised, of which $640.75 was given to the- Gross 
Library and $145.90 to the obstetrical library. 

In 1890 Mrs. Deborah K. Rodman donated to the 
College $5000, to be paid within five years, in memory 
of her late husband, Dr. Lewis Rodman, the income of 
which was to be used for the purchase of books. 

In 1894 Clement A. Grxscom presented $5000 to 
constitute the John D. Griscom fund. The same year 
were added 796 French and German dissertations and 
377 volumes of foreign journals, while the files of 
thirty-three of the most important French and 
German periodicals were completed. Also, in 1896 
and 1897, through the liberality of Dr. J. M. Da Costa, 
there were purchased 293 volumes needed to fill the 
gaps in the files of valuable foreign periodicals. In 
1899 Dr. George Fales Baker presented $5000 to be 
known as the Henrietta Rush Fales Baker Library 
Fund, and Mrs. Elizabeth B. Judson $1000, as the 
Oliver A. Judson Fund, of which the income was to 
be expended for the purchase of books relating to 
preventive medicine. Then followed rapidly sub- 
scriptions by Luther S. Bent, of $1000; Wm. T. Carter, 
$5000; Mrs. William F. Jenks, $7000, transferred from 
the Wm. F. Jenks Prize Fund; Wm. V. and John M. 
Keating, $1000; W. W. Keen, $5000; Casper Wistar, 

20 



306 SELECTED ADDRESSES 

$5000; Alice Gibson Brock, John H. Converse, Wm. 
W. Frazier, Charles C. Harrison, and Sara Kobel, 
each $1000, with numerous smaller sums. Many 
of these were obtained by Dr. W. W. Keen, through 
whose efforts the Library fund was raised to $50,000 
by July 1, 1900. The entire Library fund, up to 
November 1, 1909, amounted to $65,332, not includ- 
ing the George B. Wood bequest of $7581 for pur- 
poses other than the purchase of books (salary of 
librarian, etc.). 

Other noteworthy gifts in books were a large por- 
tion of the libraries of Dr. Alfred Stille, Dr. J. M. 
Da Costa, and Dr. John Ashhurst, Jr., all of whom 
died in 1900. Almost the entire library of Dr. Stille* 
had been given during his lifetime to the Lewis 
Library before Dr. Lewis's death, in 1890. It included 
many rare and valuable books. 

Dr. Da Costa's library was received in 1900. It 
included 2466 books, among which were many ele- 
gantly bound volumes. Fifteen hundred volumes 
were selected from the library of Dr. John Ashhurst, 
many of which were rare and all valuable. 

In 1900, also, were received 6963 theses and 
inaugural dissertations, and there was arranged, 
chiefly through the efforts of the president, Dr. Keen, 
an exchange with six universities, French, German, 
and Spanish. These exchanges have been increased 
through Dr. Keen's efforts, in 1908, to twenty-six 
universities. Nine hundred and forty-eight inaugural 
theses were received in the year 1907, and through the 
efforts of Dr. W. W. Keen, Dr. Wm. Osier, Dr. A. J. 
Magnin, and Dr. Louis Landouzy, Dean of the Paris 
Faculty of Medicine, it has been arranged that we re- 
ceive in exchange for our Transactions the forty or 
fifty volumes of the Paris theses published each year. 
With a view to further completing our files of the 



DEDICATION ADDRESS 307 

Paris theses, by an appeal to Fellows there was raised 
a sufficient sum to complete our files from 1882 to 
1907, more than 850 bound volumes. From delayed 
shipment, however, these volumes did not arrive in 
time to be included in the accessions to the Library 
reported by the librarian for 1908. They will, how- 
ever, be included in the report for 1909. 

In 1901 was secured, through subscriptions by Dr. 
S. Weir Mitchell, Dr. George Fales Baker, and Dr. 
John K. Mitchell, the library of the late Dr. J. 
Stockton Hough, a unique collection numbering 3247, 
and 2070 pamphlets, of which 1500 volumes and 1030 
pamphlets were retained, the remainder being sold 
to the University of Pennsylvania for $1500. 

In 1902 the ophthalmological library of the late Dr. 
Wm. F. Norris, consisting of 1177 volumes, and 
constituting one of the most valuable collections of 
works on ophthalmology, was presented by his family. 
In 1903 Dr. George W. Norris presented three volumes 
containing the collection of colored eye grounds made 
up of the original drawings and notes of Professor 
Jaeger, of Vienna, from which the well-known Jaeger 
atlas was produced, and purchased by his father, Dr. 
Wm. F. Norris, for $2400; also a volume containing 
the collection of ophthalmological drawings from cases 
seen in the practice of Dr. Norris from 1873 to 1901. 

In 1904 the library of the late Dr. Thomas M. Drys- 
dale, 958 volumes, was received. 

In 1905 the Board of Managers of the Episcopal 
Hospital presented its library of 1982 volumes, and 
Dr. J. V. Ingham gave 548 volumes. 

In 1907 the late Mr. John Lambert left in his will 
$5000 to the Library as a memorial to his cousin, Dr. 
W. F. Norris. 

The Elizabeth K. Newcomet fund of $1000 was con- 
tributed by her son Dr. Wm. S. Newcomet in 1908. 



308 SELECTED ADDRESSES 

Dr. Keen's unceasing efforts brought further fruit 
in the purchase abroad, in 1908, of thirty- three rare 
and valuable medical works, of which twenty-one 
were incunabula (printed in the fifteenth century), 
and two, though not incunabula, are of great value. 
They are a copy of the works of Avicenna in Arabic 
text (1593) and a fine edition of photographic fac- 
simile of the Dioscorides Codex, in two large folio 
volumes, published in Leipzig, 1906. Dr. Keen was 
aided in the purchases by the liberal subscriptions of 
a few friends of the College. 

Mention should be made of the Nurses' Directory 
as a liberal source of revenue to the Library. Estab- 
lished May 15, 1882, it has not only been a great boon 
to_ the community in promptly furnishing efficient 
nurses, but has also contributed to the College during 
the years 1900 to 1907, inclusive, over $15,000, all 
expended in the purchase of books. 

The total number of bound volumes up to November 
1, 1909, was 81,018; General Library, 63,890; Lewis 
Library, 13,536; S. D. Gross Library, 3375; Obstet- 
rical Society Library, 217. There are also: Unbound 
Reports and Transactions, 8202; unbound Theses 
and Dissertations, 23,711 ; unbound Pamphlets, 70,213. 

Between 2000 and 3000 volumes are purchased 
annually with funds of the College, and many are 
donated by authors, publishers, and friends of the 
College. 



XVII 
MEDICAL SOCIETY 

OF THE 

STATE OF PENNSYLVANIA 

PRESIDENT'S ADDRESS 
REVIEW 

OP THE 

PROGRESS OF MEDICINE 

DURING THE LAST HALF CENTURY 

1863—1913 



XVII 

PRESIDENTS ADDRESS: REVIEW OF THE 
PROGRESS OF MEDICINE DURING 
THE LAST HALF CENTURY 1 

To attempt a review of the progress of Medicine 
in the last 50 years implies a presumption which 
may not be justified in my case, but I assume it be- 
cause its events have been so largely coeval with my 
own life and the occasion and time seem appropriate. 

On March 13, 1863, when I received my diploma 
the Civil War between the North and South was 
raging, ushered in by the attack on Fort Sumter, 
April 12, 1861, culminating in the battle of Gettys- 
burg, July 1 to 3, 1863, and terminating in the sur- 
render of General Lee, April 9, 1865, almost exactly 
four years. 

MEDICAL EDUCATION 

At that time medical education in the United States 
was at its lowest ebb. The earliest information tabu- 
lated in the Bureau of Education at Washington re- 
specting medical schools is for 1869-70, when there were 
72 medical colleges of which 59 were of the regular 
system, 5 of the eclectic system, 7 of the homeopathic 
and 1 of the botanic system, making a total of 72. 
None required more than two annual courses of lec- 
tures, the same lectures being repeated each year. 
Three years of study were, however, considered neces- 
sary in preparation for the degree, time not occupied 

1 Delivered at the General Meeting, Medical Society of the State of 
Pennsylvania, Scran ton Session, September 24, 1912. Reprinted 
from the Pennsylvania Medical Journal, October, 1912. 

311 



312 SELECTED ADDRESSES 

at lectures being supposedly spent in " reading' ' 
under a preceptor in active practice. Nevertheless 
many were graduated after only eighteen months of 
study. The Civil War further contributed to de- 
moralization since the demand for surgeons was so 
great that many were accepted who had not yet 
received their diplomas. 

For fully thirty-four years longer medical schools 
continued to multiply until, in 1904, 148 schools were 
registered by the University of the State of New York. 
Many schools were organized purely in the interest 
of those who became professors. More recently the 
number of medical schools has been diminishing. 
Thus the bureau of education at Washington reports, 
at the close of 1910, 145 medical schools of which 112 
were regular, 14 homeopathic and 19 eclectic. At this 
writing the number has been reduced to 120. * 

MEDICAL EDUCATION OF WOMEN 

A subject of absorbing interest, at the time of my 
graduation in 1863, was the medical education of 
women. This was especially the case in Philadelphia 
where the first woman's medical college was founded 
in 1850. The discussion culminated soon thereafter 
in opening the clinics of the Pennsylvania Hospital 
to mixed classes of men and women students in the 
winter of 1864-65. The consequence was a disorderly 
and discreditable exhibition on the part of the men 
students and a resignation of one of the visiting 
surgeons opposed to the women; but so highly was 
this distinguished surgeon appreciated by the mana- 
gers of the hospital that he was reelected with the 
understanding that the women students should not 

1 See Dr. N. P. ColwelTs address at the Eighth Annual Conference 
of Medical Education, Chicago, February 27, 1912. 



REVIEW OF PROGRESS IN MEDICINE 313 

attend his clinics. With the lapse of time the opposi- 
tion diminished and for some time women and men 
have attended the clinics of the hospital in nearly- 
equal numbers. The admission of women to the state 
and county societies was contested for some time 
longer but finally prevailed, the fiercest and most pro- 
longed opposition being that of the Philadelphia 
County Medical Society and the Medical Society 
of the State of Pennsylvania. For a time, too, there 
was an indisposition on the part of men to consult 
with women physicians, which gradually grew less 
and has long since disappeared. 

SPECIALISM 

At the date of my graduation specialism had just 
begun to make its appearance in the United States, 
but those who adopted it were looked upon with dis- 
favor and suspicion. Facilitated by the laryngoscope 
the study of the larynx was among the first to be 
dignified with the importance demanding such recog- 
nition, even before the eye, which, however, soon out- 
stripped the larynx, because of the greater importance 
of the subject and evident necessity of special prepa- 
ration in optics for its better understanding. In- 
deed in the matter of the eye, the earlier specialists 
had a better scientific training than many who take 
up the subject at the present day and are assisted by 
optical appliances which enable them to work by rule 
rather than by knowledge. As the laryngoscope in 
the case of the larynx, so the ophthalmoscope proved 
a powerful impetus to the study of the eye. The ear 
claimed attention simultaneously with the eye and 
at first from the same specialist. Latterly it has come 
to be associated with the throat and nose. 

After the eye, nose and throat, gynecology as a 



314 SELECTED ADDRESSES 

specialty sprang rapidly to the front. The treatment 
consisted at first especially in topical applications for 
inflammation of the uterus and in the use of pessaries 
of various shapes for uterine displacement. Operative 
procedures were later added among which ovariotomy 
was early conspicuous. 

ANESTHETICS 

In 1863 ether and chloroform had been in general 
use for a dozen or more years, though there was some 
difference of opinion, as at the present day, as to the 
relative safety of the two. In America ether was pre- 
ferred, being regarded as safer, while in England chlo- 
roform was the favorite. But in the United States 
as well there were a few surgeons, among whom Prof. 
Samuel D. Gross was conspicuous, who preferred 
chloroform on account of its prompt and undisturbing 
effect, regarding it as safe as ether when administered 
properly. Amputations were, however, occasionally 
done then, as now, without a general anesthetic, be- 
cause of the desperate weakness of the patient, and 
I can recall such operations during the Civil War by 
my surgeon-in-chief, John Neill, in charge of the mili- 
tary hospital at Broad and Cherry Streets, Phila- 
delphia. Laudanum and whiskey were substituted 
and the patients showed surprising indifference, and 
did well. 

Since then a variety of anesthetics, general and local, 
have come into use, but they have been short lived 
except nitrous oxid for general anesthesia and cocain 
or some of its modifications for local anesthesia. The 
former, being perfectly safe, is much used for short 
operations and previous to ether, to hasten the action 
of the latter. Only its costliness interferes with its 
more general use in longer operations. Cocain and 
eucain when skillfully availed of are very efficient 



REVIEW OF PROGRESS IN MEDICINE 315 

local anesthetics. Eucain is at once more efficient 
and harmless. Spinal anesthesia has acquired popu- 
larity among a few surgeons. 

THE CLINICAL THERMOMETER AND HYPO- 
DERMIC SYRINGE 

I do not remember having seen a clinical ther- 
mometer or a hypodermic syringe while I was an 
intern in the Pennsylvania Hospital in 1863-64, nor 
in my military hospital service, 1862-65. 

In the matter of clinical thermometers, George 
Armatage in a little book entitled "The Thermometer 
as an Aid to Diagnosis in Veterinary Medicine" 1 
says the earliest use of it in England among veteri- 
narians was by Prof. Gamgee in 1865, although he 
says also, quoting Flemming, that the thermometer 
was used as a test for morbid temperature by Paulet 
in the middle of the eighteenth century. I find in 
the catalogue of the Surgeon General's Library, a 
title, "A Thermometer for the Human Body," by 
Spurgin, dated London, 1852. Abraham Flexner in 
his report to the Carnegie Foundation on Medical 
Education in Europe says that while the clinical 
thermometer was known to Boerhaave (1668-1738 
it first came into general use through the clinician 
Traube in 1850. In his classic work on " Medical 
Thermometry/' 1870, Wunderlich says " Ever since 
Oct., 1851, I myself, induced by Traube's recommen- 
dations have introduced the use of the thermometer 
in my clinic." Its use did not, however, become 
general. The date of its popular use has perhaps been 
set as nearly as possible by Cornelius B. Fox in a paper 
on the "Clinical Thermometer," published in 1869, 
in the Medical Times and Gazette, where he says, 

1 Third edition, 1894. 



316 SELECTED ADDRESSES 

" Every practical physician has doubtless ere this made 
the thermometer as much a companion as the stetho- 
scope." At that time no thermometer was thought 
reliable unless made by Hicks or Hawksley and tested 
at Kew Gardens. Ar mat age says that we are in- 
debted for the perfection to which it has been raised, 
to L. Casella, instrument maker to the admirality 
at 147, Holborn, London. Casella published cata- 
logues and lists of instruments in 1865-71. To him 
Armatage ascribes the suggestion of the self-registering 
feature. 

In the matter of the hypodermic syringe the history 
of its introduction is a complicated evolution of which 
it is exceedingly difficult to determine precisely the 
different stages. About 1836 Laf argue published the 
results of observations on the insertion of morphin 
under the skin along the "trajectory" of nerves 
affected with neuralgia, he having invented a needle- 
trocar with which he deposited morphin in the form 
of paste. This method was pursued by others in 
France, Germany and America, our own country 
being represented by Drs. Taylor and Washington 
of New York, who, in 1839 or thereabouts, modified 
the process by substituting for the paste, morphin in 
solution, injected under the skin with an Anel syringe 
which Bartholow 1 calls the progenitor of the modern 
instrument. It was a small syringe with an elongated 
tapering nozzle fine enough to enter the lacrymal duct, 
readily converted into a hypodermic syringe by " cut- 
ting a point on the small extremity of the cannula." 
The first injections with the Anel syringe were done 
through an opening in the skin previously made for 
the purpose. Taylor and Washington lost much of 
the credit due them by their failure to publish their 
results until others had anticipated them. 

1 Bartholow: Hypodermic Medication, Fifth edition, 1891, p. 18. 



REVIEW OF PROGRESS IN MEDICINE 317 

Priority in the employment of the hypodermic 
syringe was claimed by several. Thus Sieveking 
claimed it for Kurzak of Vienna, but seems unsup- 
ported by other authority. Priority is commonly 
acceded to Dr. Alexander Wood of Edinburgh, who 
began in 1843 the use of a crude syringe, similar to 
that of Anel, with which he injected a solution of 
morphin also through an opening made in the skin. 
G. Judas in a Strasburg thesis for the doctorate, 
entitled " Introduction of Medicine Hypodermically," 
1864, thus alludes to Wood's syringe: "A. Wood 
injected medicine under the skin with a little syringe 
made by Ferguson which was, however, soon replaced 
by the syringe of Pravaz." Thus is explained, another 
name still used in France and Germany. Pravaz 
was a physician of Lyons in France who recommended 
this method about 1860. 

Wood 1 did not publish his results until 1855, twelve 
years later. In the meantime, having become familiar 
with the process, others applied it, claiming more or 
less priority. Among these may be named Mr. 
Rynd of Dublin who says, "The subcutaneous in- 
jection of medicinal substances to combat neuralgia 
was first used by myself in the Meath hospital in 
1844." 

Until a short time prior to 1859 the curative results 
were believed to be purely local and it was considered 
essential that the injection should be made at the pain- 
ful spot. This was also the view of Dr. Wood who, 
however, appreciated also the systemic effect. So, 
too, morphin was the only drug thus far used. To Mr. 
Charles Hunter of London is due the important 
demonstration that it is unnecessary to make the 
injection at the seat of the pain. His results, first 

1 Edinburgh Medical and Surgical Journal, 1S55, Bartkolow, op. 
citat., p. 20. 



318 SELECTED ADDRESSES 

determined by experiments on animals and confirmed 
by application to human beings, are thus summed 
up: " Hypodermic injections act by absorption; they 
act quicker than by the endermic method or stom- 
achic doses; they act more effectually; and a small 
dose injected is equivalent to a much larger one by 
the stomach." 

Hunter's work was extensive, including experiment 
and clinical observation. His first paper was pub- 
lished in 1859 and was entitled " Experiments Rela- 
tive to the Hypodermic Treatment of Disease.' ' 
Publications were made in all the important British 
medical journals and in 1865 he issued a pamphlet on 
"The Speedy Relief of Pain and Other Nervous Affec- 
tions by Means of the Hypodermic Method, London, 
1865." He did much through personal effort in 
enlisting the cooperation of physicians and surgeons 
of London. Thus a knowledge of the new method 
spread through England, France, Germany and 
Austria. In 1867, Dr. Albert Enlenberg, in the second 
edition of his book on the subject, published a list of 
220 articles and essays, written 1855 to 1867 in various 
languages but chiefly in German. 

The hypodermic method of Wood, defined and ex- 
tended by Hunter, was introduced in the United States, 
according to Bartholow, by Fordyce Barker who, 
while in Edinburgh in 1856, was presented by Professor 
Simpson with a hypodermic syringe and used it on 
his return to New York in May of that year. The 
first published report of the method in this country 
was by Ruppaner in the Boston Medical and Surgical 
Journal in 1860. 

It is pretty evident, therefore, that the more general 
use of these instruments, the clinical thermometer 
and the hypodermic syringe, followed the close of the 
Civil War in 1865. 



REVIEW OF PROGRESS IN MEDICINE 319 

FEVERS 

At the time of my graduation the separation of 
fevers had been completed. The eruptive fevers were 
as a rule easily diagnosed; typhoid and typhus were 
no longer confounded, nor were typhus and relapsing 
fevers, while the last two had become quite rare in 
this country though epidemics of both occurred after 
I graduated. The malarial fevers in their typical 
forms were easily recognized but certain remittent 
forms now known as estivo-autumnal were still being 
confused with typhoid, the laboratory tests now so 
valuable . being then unknown. An interesting mis- 
take grew out of the Civil War in which there occurred 
among the soldiers in the field many cases of typhoid 
fever and of malarial fever which under the inspiration 
of J. J. Woodward, an eminent surgeon of the army 
in charge of the Medical History of the war, grew to 
be regarded as a mongrel affection the results of the 
combined action of the causes of the two diseases. 
Although the laboratory methods of diagnosis now in 
vogue were then unknown, even at that day there 
were many who would not accept the view. Later 
studies by modern methods of clinical material fur- 
nished by the Spanish American War refuted entirely 
its claims but discovered also that the separate 
causes of the two diseases might be in the blood at 
the same time and that after typhoid fever had ter- 
minated, the malarial protozoon could at times be 
found and the cure could be completed by quinin. 
The malarial fever had been for a time in abeyance. 

ABDOMINAL SURGERY 

Abdominal surgery, except oophorectomy, was 
scarcely known. This operation introduced in 1809 
by Ephraim McDowell of Kentucky was being done 



320 SELECTED ADDRESSES 

by John and Washington Atlee in Pennsylvania, by 
Kimball and Walter Burnham 1 in New England, by 
Sir Spencer Wells, Knowsly Thornton and Charles 
Clay in England and by Thomas Keith in Scotland. 
There was, however, still much prejudice against it 
and I remember well the emphatic remark of a pro- 
fessor of surgery in the University of Pennsylvania 
who as late as 1869 said to me, "I would not let Atlee 
touch a relative of mine with a ten-foot pole/' Never- 
theless ovariotomy became rapidly popular; in fact, 
reached such popularity that it was done at times 
needlessly and for reasons not now deemed sufficient. 
While it is true also that ever since Julius Cesar was 
extracted from his mother's womb by Cesarean sec- 
tion, this operation has been done from time to time 
on women with narrow pelves, the instances prior to 
1863 were few. With the introduction of antiseptic 
surgery it became a comparatively frequent operation. 
Antisepsis gave a great impetus to abdominal surgery 
which has grown until at the present day it may be 
truly said that there is scarcely an organ of the ab- 
domen which has not been successfully removed. 

SPONTANEOUS GENERATION AND 
CELLULAR PATHOLOGY 

The theory of spontaneous generation was the sub- 
ject of lively dispute for some time after I graduated 
although it had received a mortal blow at the hands 
of Pasteur through observations and experiments in 
1860-64 culminating in a demonstration at the 
Sorbonne, April 7, 1865, before an audience which 
included, besides professors and students, such celeb- 
rities as Duruy, the minister of public instruction, 
Alex. Dumas, Sr., George Sand and the Princess 

1 Burnliam is said to have reported 350 operations done mostly at 
the homes of patients previous to the fifties. 



REVIEW OF PROGRESS IN MEDICINE 321 

Mathilde. Thus was established the dictum Omne 
vivum e vivo. Simultaneously in Germany , Virchow, 
on whose banner was emblazoned the device Omnis 
cellula e cellula, carried the same conviction into 
physiology and pathology, his results being further 
confirmed by the later studies of his countrymen, 
Robert Koch and Ferdinand Kohn in 1876. l Pouchet 
and his followers in France and Charlton Bastian and 
Prof. Owen in England continued the fight for a 
time but the opposition eventually ceased and spon- 
taneous generation has practically no advocates to- 
day. Among those who disputed facts brought for- 
ward by Pasteur were the Baron Liebig (1870-72) 
and Prof. G. Colin, an eminent veterinarian but a 
bitter and unfair opponent of Pasteur. 

This important biological doctrine so closely re- 
lated to the origin of disease claimed the attention of 
the earliest philosophers and students of nature. 
The use of the microscope in its crude form tended at 
first to favor the theory. Such was the conclusion 
in 1671 of Kircher, a Jesuit priest, and four years later 
of Lowenhoek, a Dutch linen merchant, as the result 
of their minute study, such as it was, of decomposing 
animal matter of various kinds. On the other hand 
Plenciz of Vienna after like studies in 1762 declared 
that the phenomena of disease and the decomposition 
of animal fluids were entirely caused by living things 
(animalcules) which he found in these morbid condi- 
tions. Both sets of observations were crude and un- 
convincing but the weight of opinion was in favor of 
spontaneous generation. The doctrine prevailed more 
or less until effectually overthrown by Pasteur, Vir- 
chow, Koch and Kohn. 

1 Long before this, Introductory Lectures, 1S53 and 1S5S, Prof. 
Joseph Leidy in this country said of the microscope that it contributed 
to overthrow the doctrine of spontaneous generation. 

21 



322 SELECTED ADDRESSES 

THE GERM THEORY 

The parasitic or germ origin of disease was the 
direct result of the establishment of the dictum 
omne vivum e vivo. A remarkable series of observa- 
tions bearing on it preceded its final adoption, which 
deserve brief mention. In 1841 Henle published a 
prophetic paper entitled, " Von den Miasmen und 
Kontagien" which foretold with remarkable accuracy 
of detail the fundamental conditions of the germ 
theory. Fifteen years later (1856-59) Pasteur showed 
that the tartaric fermentation, the lactic, the alcoholic 
and acetic fermentations are correlated to a phe- 
nomenon of life, "an organization of globules" (cells). 
About the same time Cornalia was studying the little 
brown and black spots on the diseased silkworm, known 
as " corpuscles," paving the way for the magical re- 
sults of Pasteur's later study of the same disease, by 
which the medical profession and the scientific world 
generally were to be aroused to the significance of 
germ life as the cause of disease in the higher animals. 
In his experiments Pasteur showed that infusions of 
organic matter, in which all germs had been destroyed 
by boiling, would remain pure not only for days but 
for months and even years, even when exposed to 
the air if germs were excluded. In like manner he 
showed that alterable liquids like blood and urine 
could be exposed to the contact of air deprived of 
its germs without undergoing the least fermentation 
or putrefaction. 

These facts being determined, in May, 1865, 
Pasteur undertook the investigation of pebrine, or 
silkworm disease, which was ravaging the silkworm 
culture districts of the world. Beginning in 1845, 
by 1849 it had become a scourge, and by 1864 healthy 
eggs or seed could be found only in Japan. The dis- 



REVIEW OF PROGRESS IN MEDICINE 323 

ease developed as the so-called "corpuscles" which 
were little brown or black spots formed by the invasion 
of a bacillus of doubtful classification. They were 
found chiefly in the moths and chrysalides but also 
in the eggs and worms. Pasteur early concluded that 
it was not a new disease but merely an aggravation of 
what had always existed, easy of recognition by the 
microscope and remediable. 

By his extensive and thorough studies all that he 
predicted was verified; while his method of opposing its 
spread, which was simply complete destruction of all 
infected worms and propagation by healthy eggs alone, 
was completely successful. By these means the 
disease was conquered by the end of the year 1869 
and another link in the chain of the germ theory of 
disease forged. The energy with which Pasteur 
pursued the study of this subject possibly contributed 
to cause a paralytic stroke which overtook him on 
October 19, 1868, when he had just about concluded 
this work. Within a year, however, he had recovered 
and was soon again absorbed in one of the problems 
to which he was constantly devoting himself in the 
pursuit of scientific truth and human betterment. 

At this time also, 1860-65, was progressing on the 
other side of the English channel a work scarcely less 
important in its bearing upon the origin of disease, 
a work less appreciated than it deserves, embracing 
as it did more than a germ of the truth. It was 
that of Lionel S. Beale, then professor of physiology 
in King's College, London. Like Pasteur he denied 
spontaneous generation and sought earnestly to refute 
it by methods similar to those of Pasteur. He was 
among the first to use the highest powers of the micro- 
scope and staining methods in demonstration of tissues 
which he resolved into germinal or living matter 
and formed material. To the former he also applied 



324 SELECTED ADDRESSES 

the term bioplasm, meaning simply living matter. It 
is justified for the same reason that the word biology 
is justified. Beale objected to the term protoplasm, 
then coming rapidly into use in Germany, England 
and America, because of the vagueness attached to 
it. Any living particle, however small, is a bioplast. 
A living white blood corpuscle for example, he said, 
is a mass of bioplasm or it might be termed a " bio- 
plast." Bioplasm may have widely different prop- 
erties benignant or malignant but it is structurally 
the same, i. e., structureless. Bioplasm is self -propa- 
gating. Bioplasm is represented by nucleus and 
nucleolus while cell wall and peripheral cell contents 
are formed material into which bioplasm is being con- 
stantly converted at its periphery. So are the fibrillse 
of connective tissue and tendon and the contractile 
substance of muscle, all of which he called formed 
material. Minute fungi and bacteria are bioplasm. 
Disease germs are bioplasm; but they, according to 
Beale, are the fragments or offshoots from other dis- 
ease germs and not independent living entities. The 
air contains many disease germs of various degrees of 
virulence as well as germs which are harmless. In- 
fusions of organic matter exposed to the air become 
rapidly swarming with such germs. Thus far Beale 
and Pasteur agreed but here they separated. Accord- 
ing to Pasteur disease germs are separate living en- 
tities of vegetable nature whereas according to Beale 
they are living particles derived from preexisting 
unorganized diseased animal matter. They are not, 
according to Beale, spores or bacteria, as Pasteur held, 
and Beales says flatly, "I am quite unable to sub- 
scribe to the argument advanced in favor of the 
vegetable germ theory of disease." 



REVIEW OF PROGRESS IN MEDICINE 325 

TUBERCULOSIS 

An early and important ground work in the evolu- 
tion of the germ theory was the morbid process known 
as tuberculosis, having its most vivid expression in 
tuberculosis or consumption of the lungs. The con- 
tagiousness, the inoculability, in a word the specificity 
of the tubercle, proved by Villemin of Vale de Grace 
in 1865, and confirmed three years later by Wilson 
Fox in England, was an important advance although 
it elicited the contemptuous denial of the French 
school of physicians who were wedded to the theory 
of spontaneous generation. Villemin did 'not dis- 
cover the bacillus of tuberculosis. This was left for 
Koch in 1882 but Villemin first suspected the existence 
of a communicable virus and proved it by experi- 
ment. Previous to this had arisen the short-lived 
theory of the duality of phthisis, accepted for a time 
(1857-70) by Virchow, Buhl, Niemeyer and Rind- 
fleisch, according to which the gray granulation or 
miliary tubercle was the only true tubercle while 
what was known as yellow or crude tubercle was 
nothing but cheesy inflammatory material, whence 
however arose the virus whose inoculation produced 
the grey granulation or ture tubercle. The subjects 
of this cheesy infiltration were regarded as " phthisical 
but not tuberculous " until affected by miliary tubercle. 
Whence Niemeyer's dictum, announced in his classic 
lectures on pulmonary tuberculosis, "The greatest 
danger to most phthisical patients is the develop- 
ment of the tubercle." This theory was overthrown 
by Koch's discovery and gave way to the dictum 
now generally adopted that " all phthisis is tubercular. " 

ANTHRAX 

Very much the same reception was accorded in 
France to Davaine's discovery in 1863 of the bacillus 



326 SELECTED ADDRESSES 

of anthrax or gangrene of the spleen, a pest of great 
virulence which was destroying thousands of cattle 
and sheep in certain parts of France and elsewhere. 
As far back as 1838, Delafond, a professor in the 
Alfort veterinary school, had demonstrated micro- 
scopically certain little rods in the blood of sheep dying 
of gangrene of the spleen, or "charbon" as the French 
also call it, but Delafond attached no importance to 
them. Pollander saw them in 1849, Davaine and 
Rayer in 1850. But their import was not recognized 
until eleven years later when, after reading Pasteur's 
paper on the butyric ferment, it occurred to Davaine 
that the filiform bodies seen in the blood in this disease 
might act like ferments and thus cause it. He 
proceeded to settle the question by inoculating rabbits 
with the blood of sheep that had died of it. Recog- 
nizing in the blood of the rabbits thus inoculated the 
same filiform threads, he called them bacteria and 
assigned them a place in the classification of living 
beings. The conclusion that they were the agents 
which caused the disease was, however, still deferred 
because of conflicting observations until Koch in 
Germany in 1876 and Pasteur in France in 1877 com- 
pleted the link necessary to prove the announcement 
by Pasteur that " anthrax is therefore the disease of 
this bacteridium, as trichinosis is the disease of 
trichina, as itch is the disease of the special acarus, 
with the circumstance, however, that in anthrax the 
parasites can only be seen through a microscope when 
very much enlarged." 

CHICKEN CHOLERA AND VACCINATION BY 
ATTENUATED VIRUS— IMMUNITY 

In 1869 Moritz, an Alsatian veterinary surgeon, 
noticed certain specklike granulation on the bodies 



REVIEW OF PROGRESS IN MEDICINE 327 

of chickens struck dead with chicken cholera. Nine 
years later, 1878, Perroncito, an Italian veterinarian, 
figures the microbe contained in these granulations. 
Cultures were attempted but failed until Pasteur 
succeeded finally in 1880 with a broth of chicken 
gristle. Thence he learned that the microbe belonged 
to quite another group from the vibrios of splenic 
fever, intensely virulent to certain animals, as the 
chicken and rabbit, but almost harmless to the guinea 

Pig. 

However great the importance of the studies of the 

chicken cholera from the commercial and food stand- 
point (and it was very great), it was infinitely increased 
by the fact that they furnished the key to the success- 
ful treatment of certain infectious diseases of animals. 
What the silkworm disease contributed to the etiology 
of these diseases chicken cholera did for their treat- 
ment, for it was through chicken cholera that the effect 
of injection of attenuated virus became known. 
Some hens were inoculated with an old culture which 
had been put away and forgotten. The hens became 
ill but to the surprise of the experimenters they re- 
covered. These same hens were then inoculated 
with some new virulent culture, but the " phenomenon 
of resistance" recurred. Then by using cultures of 
different ages, variations of mortality were obtained, 
eight hens dying out of every ten, then five, then only 
one and when the culture had become quite stale, none 
died, although the microbes could still be cultivated. 
Exposure to the air had produced this attenuation. 
Nay more, while hens which had never had chicken 
cholera perished when exposed to the deadly virus, 
those which had previously received attenuation inocu- 
lations and afterwards received more than their 
share of the deadly virus were affected with the disease 
in a mild form, sometimes even remained perfectly 



328 SELECTED ADDRESSES 

well. They had acquired immunity. This suggested 
to Pasteur that through artificial cultures there might 
be found a virus protective not only against the viru- 
lent diseases of cattle but also against others to 
which human beings are subject, as had already 
been done in the case of smallpox. The first applica- 
tion was made in vaccinating cattle against cowpox. 
In 1877-78 Raynaud in France, by injecting serum 
from a calf that had had cowpox, prevented the appear- 
ance of the disease in a calf freshly inoculated with the 
virulent poison. In August, 1880, Toussaint, a young 
professor in the Toulouse veterinary school, an- 
nounced that he had successfully vaccinated sheep 
against splenic fever; but his methods were defective 
and it was left for Pasteur to complete the demon- 
stration. This he did conclusively with the aid of 
his assistants, Chamberland and Poux, in a complete 
series of experiments concluded June 5, 1881. On 
June 13 he said at the Academie des Sciences: "We 
now possess virus vaccines of charbon, capable of 
preserving from the deadly disease, without ever being 
themselves deadly, living vaccines, to be cultivated 
at will, transportable anywhere without alteration, 
and prepared by a method which we may believe 
susceptible of being generalized, since it has been the 
means of discovering the vaccine of chicken cholera. 
By the character of the conditions I am now enumerat- 
ing, and from a purely scientific point of view, the 
discovery of the vaccine of anthrax constitutes a 
marked step in advance of that of Jenner's vaccine, 
since the latter has never been experimentally 
obtained." 1 

Thus are linked the names of Jenner and Pasteur, 

1 In this country, Salmon and Smith in 1896 injected small and 
repeated doses of hog cholera into healthy swine and thus made them 
innocuous, 



REVIEW OF PROGRESS IN MEDICINE 329 

the former discoverer of vaccination and exorciser 
of a disease the most loathsome and among the 
most deadly to which man is subject, the latter the 
agent through whom vaccination has accomplished 
the banishment of a disease of domestic animals 
more terrible than is smallpox for men, and ultimately 
to the stamping out of other infectious diseases of 
man. 

ANTISEPTIC SURGERY 

During the Civil War I served as a dresser and 
acting assistant surgeon in U. S. A. hospitals of 
Philadelphia, where I had abundant opportunity to 
watch the progress of the treatment of wounds and 
operations. They for the most part did badly. 
Suppuration, pyemia, hospital gangrene, erysipelas 
and bed sores were found in every ward. Such a 
state of affairs, however, was not limited to this 
country but prevailed the world over. 

Among those especially impressed was Joseph Lister, 
then regius professor of surgery in the Glasgow Uni- 
versity and surgeon to the Royal Infirmary of Glas- 
gow. He sought to combat the unfortunate condi- 
tion in his own wards by scrupulous cleanliness but 
in vain. He then recalled the fact that subcutaneous 
fractures which occurred without breaking of the skin 
did very differently from compound fractures, healing 
promptly without complication, and he concluded 
that the difference was due to the decomposition and 
putrefaction of blood diffused through the tissues and 
between the ends of the bones, thus substituting a 
fluid of an acrid character for the ordinary bland and 
unirritating normal blood. Along side of these facts 
he placed the philosophic researches of Pasteur who 
had demonstrated convincingly that it is not to its 



330 SELECTED ADDRESSES 

oxygen or to any of its gaseous constituents that the 
air owes this property of decomposing organic matter 
but to ' ' minute living particles suspended in it, which 
are the germs of various low forms of life shown by 
Pasteur to be the essential cause of putrescence, 
resolving the organic complex compounds into sub- 
stances of simpler composition, just as the yeast 
plant converts sugar into alcohol and carbonic acid." 
Along side of this Lister also placed the then recently 
acquired knowledge of the effects of carbolic acid on 
the sewage of the town of Carlisle. England, in 1864, 
where it was found that this substance not only pre- 
vented all odor from the lands irrigated with refuse 
material but destroyed also the entozoa which 
usually infest cattle grazing on such pastures. He 
concluded that so powerful an antiseptic was pecul- 
iarly adapted for experiments of the kind he was then 
making with a view to clearing up the difficulties 
which presented themselves. He made his first 
attempt in 1865 in the Royal Infirmary of Glasgow 
in a case of compound fracture of the leg which he 
treated with carbolic acid. I will not follow him in 
his early failures, partial successes and successes, 
other than to say that the ultimate results were 
brilliant triumphs. These results were formally an- 
nounced by Lister in a paper read before the British 
Medical Association in Dublin, August 9, 1876, en- 
titled the " Antiseptic Principle in the Practice of 
Surgery." These results, he claimed, established con- 
clusively that the unhealthy course of such injuries 
was due to germs introduced, with the air, to con- 
taminated dressings or to unclean hands of the 
surgeon. 

Other papers reaffirmed these results but this 
did not satisfy Lister. He repeated in the most 
patient manner the experiments of Pasteur in the 



REVIEW OF PROGRESS IN MEDICINE 331 

support of the germ theory of putrefaction, confirming 
his results in every particular. He gradually extended 
the antiseptic methods to all operations and wounds. 
His practice at first included not only the direct 
applications of carbolic acid but sprays of the same 
substance diffused through the operating room, to 
prevent atmospheric contamination by putrefactive 
organisms during operations. The usefulness of this 
measure was questioned after a time and Lister 
ultimately discarded it, admitting with true scientific 
ingenuousness that he was ashamed of having 
ever recommended it for the destruction of microbes 
in the air, thus seconding one of his German critics, 
Bruns, who said, "Fort mit dem Spray." Though 
antiseptic washes and irrigations were continued some 
time longer they were ultimately discontinued and 
asepsis was substituted for antisepsis with results as 
complete and that, too, in operations which twenty- 
five years ago would have been regarded as fraught 
with danger and criminal indifference to life. 

Let us pause here to compare very briefly the two 
men whose united work accomplished so much for 
humanity, Pasteur and Lister. Both represented the 
upper middle class to which the best education was 
possible, in both countries, the former receiving his 
at Besancon Royal College where he became a Bachelor 
of Science in 1842, the Ecole Normale and the Sor- 
bonne; the latter at University College, London, and 
the University of London where he received the degree 
of A.B. in 1847. Both were untiring students, both 
indefatigable and precise investigators, testing every 
step by innumerable experiments. Pasteur was quick 
and excitable with strong features and a certain stern- 
ness of expression quickly dissipated by change of 
thought, humane and gentle alike to animals and 
human beings. Lister, cool and unexcitable, had 



332 SELECTED ADDRESSES 

also a strong face with kindly expression, patient and 
cheerful. Pasteur died September 28, 1895, aged 
seventy- three; Lister, February 11, 1912, aged eighty- 
five. Had Pasteur lived to the day of Lister's death 
he would have been ninety. Each received the highest 
honors it lay in the power of his country to bestow: 
Pasteur, fellowship among the immortals of the French 
Academy and adoration of his countrymen; Lister, 
a peerage and the homage of the Anglo-Saxon race. 

HYDROPHOBIA 

The year 1880 as yet knew no remedy for hydro- 
phobia, a fatal disease, the horror and pathos of whose 
terminal symptoms are known the world over. The 
fact had not escaped Pasteur's notice and he was 
awaiting his opportunity. Hence when two mad 
dogs were brought to the laboratory of the Ecole 
Normale by M. Bourrell, an old army veterinarian, 
Pasteur promptly seized the chance and soon located 
the poison in the cerebral cortex and medulla oblongata 
of the animal, in addition to its saliva where it had 
been located by Bouley in 1870. Previous to Pasteur, 
Duboue* of Pau, suggested these new sites but it was 
conjecture, unsupported by experiments. On the 
other hand, M. Galtier, a professor in the Lyons 
Veterinary School, had failed in every instance to pro- 
duce the disease by inoculating nervous matter from 
the cerebellum and medulla oblongata of rabid dogs. 
Pasteur succeeded by a rigorous technic not known in 
other laboratories and in his report to the Academy 
of Medicine in 1881 announced that "the seat of the 
rabid virus is not in the saliva only; the brain contains 
it in a degree of virulence at least equal to that of the 
saliva of rabid animals," 



REVIEW OF PROGRESS IN MEDICINE 333 

Next he sought a method by which rabies could be 
contracted more surely and more swiftly, to increase 
its virulence. The microbe had so far eluded isolation. 
Pasteur had been unable to cultivate it in an artificial 
medium and decided to try the brain of living rabbits 
as a culture medium. In fourteen days hydrophobia 
appeared. Successive inoculations were made and as 
soon as a trephined and inoculated rabbit died para- 
lyzed, a little of his medulla was inoculated into an- 
other. The time of incubation became shorter and 
shorter until after one hundred uninterrupted inocula- 
tions it was reduced to seven days. Pasteur had suc- 
ceeded in intensifying the virulence. He could predict 
the exact time when death would occur. This virulent 
virus he called " fixed " virus in contradistinction to 
that conveyed by the bite of a mad dog. The next 
step was to diminish the degree of virulence. Pasteur 
applied the knowledge he had acquired in the study 
of chicken cholera and anthrax. He secured the at- 
tenuation by suspending in a sterilized vial, kept dry 
by fragments of caustic potash, portions of medulla 
from an inoculated rabbit until its virulence was 
extinguished, a fortnight being required. The at- 
tenuated virus thus obtained was injected under the 
skin of dogs and followed the next day by injection 
of medulla desiccated for thirteen days, next twelve 
days, next eleven days and so on until the highest 
degree had again been reached. Dogs thus treated 
might be bitten by rabid dogs or inoculated intra- 
cranially by the deadly virus and yet resist both. 

Pasteur was now ready to apply the treatment to 
human beings. On July 6, 1885, a little Alsatian boy 
nine years old named Joseph Maister, who had been 
bitten two days before by a mad dog, came with his 
mother to the laboratory. Pasteur made the first 
inoculation the same evening with a few drops of a 



334 SELECTED ADDRESSES 

liquid prepared from a portion of medulla oblongata, 
fourteen days old, that had completely lost its viru- 
lence. Injections of increasing virulence were made 
from day to day and were promptly absorbed without 
untoward event. " Pasteur's anxiety was intense/' 
says his biographer, "and kept him awake at night." 
At last the final day came, July 16, at 11 a.m. The 
treatment had lasted ten days and Maister had been 
inoculated twelve times. He returned to Alsace, 
July 27, and remained cured. Pasteur had triumphed 
and this was the date of his victory. 

Notwithstanding these brilliant results the microbe 
of hydrophobia has not been isolated, only the con- 
tagium bearer has been found, whence we may con- 
clude that it belongs to the group of ultra microscopic 
germs which, like that of yellow fever, still defies the 
highest powers of the microscope. For the present 
we must be satisfied with knowing its contagium 
bearers which are the saliva and nervous matter. 



PATHOGENIC ORGANISMS 

It is impossible to follow these events in strict 
chronological order because some required months and 
even years for their evolution while others were re- 
vealed in a comparatively few hours. The bacillus 
of anthrax was the first recognized, perhaps because 
of its size, discovered in 1849-50 by Pollander and 
Davaine, though its significance was not recognized 
until much later. The spirillum of relapsing fever, 
discovered in 1873 by Obermeier in the blood of cases 
of relapsing fever, was among the first, probably, also, 
because it is a spirillum of considerable size as compared 
with the germs of other infectious diseases. 

The bacillus of leprosy resembling very closely that 



REVIEW OF PROGRESS IN MEDICINE 335 

of tuberculosis was discovered even earlier than the 
latter by Hansen in 1879. The bacillus of Eberth, 
or Bacillus typhosus, the cause of typhoid fever, was 
found by Eberth in 1880, two years earlier than the 
bacillus of tuberculosis by Robert Koch. The Klebs- 
Loffler bacillus of diphtheria was described in 1882-84 
by the men whose name it bears. The peculiar 
comma-shaped bacillus, the cause of cholera, was 
also isolated by Koch in 1884; the bacillus of tetanus, 
the most deadly of all bacteria, was found by Nicolaier 
the same year. 

The diplococcus of pneumonia or pneumococcus was 
shown by Frankel, in 1886, to be the cause of this 
disease. The bacillus of influenza, or grip, one of the 
smallest bacilli thus far recognized, was discovered 
by Canon and PfeifTer in 1902. The pleuropneu- 
monia of cattle has lately been shown by Roux and 
Nocard to be caused by a bacterium also so small as 
to be scarcely visible by existing powers of the micro- 
scope. The bacillus of plague, or Bacillus pestis, was 
isolated by Kitasato and Yersin in 1894. Syphilis 
has been ascribed to several bacilli in succession. The 
last discovered, which is commonly admitted to be the 
cause, is the Spirochaeta pallida first described by 
Schaudinn in 1884. 

It has been mentioned that in a certain number of 
diseases the pathogenic germ has not as yet been found. 
One of the most important of these is yellow fever, 
although the list includes scarlet fever, smallpox, 
measles and hydrophobia. Analogical reasoning de- 
mands their existence. Three explanations of fruit- 
less search suggest themselves. First the germs may 
be ultra microscopic in size; that is to say, they may 
be so small as to be beyond recognition by our micro- 
scopes. The possibility is supported by the fact that 
the germs already discovered vary greatly in size, some 



336 SELECTED ADDRESSES 

that are recognizable being barely so. This is true 
of the bacillus of pleuropneumonia of cattle above 
mentioned, which, if a little smaller, would still have 
remained undiscovered. Or the disease may be due 
to an organism which is at times harmless and at 
others possesses virulent qualities. Thus there is 
reason to believe that puerperal fever and appendicitis 
may be caused at times by the colon bacillus which, 
ordinarily harmless, may assume a virulent type. 
Finally, the disease may be due to an organism of a 
different type from fany yet recognized. 

THE R6LE OF INSECTS AS THE CAUSE OF 
DISEASE 

While the majority of the germs which cause disease 
are vegetable in nature a few are of the animal class, 
protozoa. The best known of the diseases thus caused 
is malarial fever of which the cause is the Plasmodium, 
malariae, discovered by the French army surgeon, 
Laveran, in 1880. Its complete development requires 
two hosts, one the blood of man the other the ali- 
mentary canal of the mosquito, whence it is communi- 
cated to man by the bite of one of the genus Anopheles 
punctipennis. The common everyday mosquito of 
this latitude is the Culex taeniorynchus whose bite is 
ordinarily harmless. Similarly transmitted is yellow 
fever whose contagious germ has not been isolated. 
The role of the mosquito in this disease was first sug- 
gested in 1881 by Charles J. Finlay of Havana, al- 
though the suggestion was without tangible support. 
It was, however, confirmed in 1890 by the experiments 
of the American Army surgeons, Ross, Lazear and Car- 
roll, of whom the last two unfortunately fell victims 
to their zeal. The mosquito concerned in this disease 



REVIEW OF PROGRESS IN MEDICINE 337 

is the Stegomyia fasciata. A third disease of human 
beings for which the mosquito is responsible is ele- 
phantiasis due to the blocking up of the lymphatics by 
a threadlike worm, the Filaria brucei, whose embryos 
live in the blood of man whence they are taken by the 
bite of the mosquito, commonly the culex, and again 
injected into man at its next meal. 

Similar is the origin of trypanosomiasis or the sleep- 
ing sickness due to the Trypanosoma gambiense, a 
worm like organism, quite as low in the scale of animal 
life as the Plasmodium malariae. It was discovered 
by Forde of Gambia in 1901. It is introduced into 
the blood of man by the bite of the tsetse-fly or 
Glossina palpalis. A similar disease, similarly fatal 
and similarly caused, occurs in horses. 

Bubonic plague also requires the intermediation 
of a host for its propagation. The Bacillus pestis is 
transmitted by a flea, Pulex cheopis, which infests the 
rat and the ground squirrel. The infected rat may 
infect other rats and human beings. The very latest 
observation in this direction though not altogether 
confirmed as yet is that the ordinary bedbug, Cimex 
lectularius, is the host which conveys the cause of 
typhus fever from one person to another. One life 
has already been sacrificed to researches on this sub- 
ject, that of Dr. Pritchett who acquired the disease 
while studying it in Mexico. That the ordinary house 
fly may be the medium of transfer of typhoid fever 
from the bacilli-laden alvine discharges to localities 
whence it may enter the alimentary canal with food 
or drink has also been determined by the events of the 
South African and Spanish American wars. Amebic 
dysentery is caused by an ameba quite like the ordi- 
nary fresh water ameba. 

The adoption of the germ theory of disease led to 
three most important advances, first, the preventive 

22 



338 SELECTED ADDRESSES 

treatment of disease; second, the diagnosis of the in- 
fectious diseases; and, third, treatment by serums and 
vaccines. 

I. THE PREVENTIVE TREATMENT OF 
DISEASE 

Attempts to prevent the occurrence of disease go 
back as far in time as disease itself, while public hy- 
giene and physical culture were developed by the 
Greeks and Romans to a high standard. In the strug- 
gle for prevention the battle cry has been " remove 
the cause" but until bacteriology reached its present 
stage of development, culminating in the finding of 
the pathogenic organisms in so many diseases, the 
search was vain; while often favoring conditions and 
predisposing causes were mistaken for the actual 
cause. Perhaps the simplest illustration of this con- 
fusion can be drawn from the familiar disease of croup- 
ous pneumonia, which so frequently follows long ex- 
posure to cold and has, therefore, been ascribed to it. 
This belief seemed further confirmed by the fact that 
in many instances the disease was ushered in by a 
chill, the meaning of which was altogether misinter- 
preted. At the present day we know that pneumonia 
is caused by the diplococcus of pneumonia, and that 
the effect of cold is simply to furnish conditions favor- 
able to its action, while the chill itself points to the 
moment of intoxication by the poison. Our efforts 
to prevent disease are therefore directed primarily to 
the organism causing it, and secondly to the favoring 
conditions without which often the specific cause can 
not operate. Every year brings further evidence to 
strengthen the views now accepted. 

The second invaluable gift of the germ theory of 
disease is its aid in diagnosis of infectious diseases. 



REVIEW OF PROGRESS IN MEDICINE 339 

II. THE DIAGNOSIS OF THE INFECTIOUS 
DISEASES 

This is accomplished in two ways, first by the 
recognition of the specific bacillus itself, as the typhoid 
bacillus in typhoid fever, the bacillus of diphtheria in 
diphtheria, that of tetanus in lock jaw and many 
others. Second by the agglutination reaction of the 
specific bacterium with immune sera or what is known 
as serum diagnosis. The latter is best illustrated by 
the well-known Gruber-Widal test in typhoid fever, 
the result of studies begun by Gruber and his pupil 
Durham in 1894. Widal's name was added because 
the significance of the reaction in diagnosis was 
pointed out by Widal although he was anticipated by 
Grunbaum. It is too familiar to need repetition here. 
It may be said, however, that its discovery marked an 
era in the history of typhoid fever and its results give 
us the nearest approach to pathognomonic evidence 
of the presence of this disease. The same reaction 
succeeds a like technic in cholera. 

THE WASSERMANN REACTION 

The most recent and important result of the study 
of bacterial physiology and pathology is the Wasser- 
mann test for syphilis. It is based upon the assump- 
tion of Ehrlich's " side-chain theory" that a given 
specific toxic agent, antigen, induces a reactive forma- 
tion of specific amboceptors in the infected organism, 
which amboceptors serve to bind the protective com- 
plement of the patient to the antigen, for the destruc- 
tion of the latter. 

Noguchi has modified the Wassermann test making 
it simpler and quite as reliable. A detailed descrip- 
tion of the technic of both methods is evidently out 
of place in an address like the present. 



340 SELECTED ADDRESSES 

III. ADVANCE IN TREATMENT 

Still another result of the germ theory of the infec- 
tious diseases is the advance in treatment which grew 
out of it resulting in treatment by serums and vac- 
cines. This improvement has not extended as yet to 
many diseases but were it limited to diphtheria alone 
its good results could scarcely be overestimated. The 
treatment which has thus arisen is loosely called serum 
treatment but if this term is retained it should be 
further divided into serum treatment proper, or 
treatment by antitoxins, and treatment by vaccines. 
The latter is also called bacterin therapy. The treat- 
ment by antitoxin depends upon the fact that in in- 
fectious diseases there is developed in the blood of the 
diseased subject an antitoxin which can be cultivated 
in another animal and extracted for use on still another 
animal having the same disease, i. e., the patient. As 
has been stated diphtheria is the disease in which the 
antitoxin treatment has been most successful. A 
similar but not as complete success has been secured 
in cerebrospinal meningitis with Flexner's antimenin- 
gitis serum. The same is true of the antitoxin treat- 
ment of tetanus and certain snake venoms. There 
seems reason to believe that a like treatment of infan- 
tile palsy may be successful. 

The treatment by vaccines, or bacterin therapy, has 
a broader application and bids fair to equal in efficiency 
in some diseases, that of antitoxin. It consisted 
originally in the introduction of the living germ or 
microbe causing the disease into the blood, a microbe 
however, of a lower grade of virulence. Thus intro- 
duced there ensues a mild type of the disease which 
insures immunity against the more virulent form. 
Vaccination for protection against smallpox is the 
most familiar instance of this treatment. In the so- 



REVIEW OF PROGRESS IN MEDICINE 341 

called opsonic vaccination, dead microbes are used. 
These do not set up a disease with a definite course 
but excite a multiple reaction, part of which is mani- 
fested by special phagocytic activities, and part by 
development of immune body. A vaccine may be in 
a solid form or it may be suspended in a fluid, as in 
salt solution or even in serum, whence the inclusion of 
vaccination under serum treatment. 

Vaccine Treatment of Hydrophobia. The most bril- 
liantly successful of the vaccinations, unless we except 
the most recent, that against typhoid fever, is that 
against hydrophobia, rendered possible by a long 
period of incubation which characterizes that disease. 
Under the circumstances the possibility of averting 
it from individuals bitten by rabid dogs occurred to 
Pasteur. I have already narrated the method by 
which he worked out this problem. Allowance being 
made for cases in which the victim escapes the disease 
because inoculation has been prevented by clothing, 
the mortality in rabies has been reduced from prac- 
tically 100 per cent for Paris prior to the introduction 
of the Pasteur treatment, to 0.94 per cent at the end 
of 1886 at the Pasteur Institute; and to 0.13 per cent 
for 1905, or a mortality of two out of 1520 inoculations. 

Treatment by Opsonins — Phagocytes. Students of 
the microscope have long been familiar with a proto- 
plasmic unicellular fresh water organism sufficiently 
large to be easily studied with moderate magnifying 
powers and known as the ameba. It is characterized 
at ordinary temperature by active ameboid move- 
ments and the capacity of ingesting food particles by 
enveloping them in its protoplasm which dissolves 
and digests them. It was soon learned that the white 
blood cells in the human organism were the analogues 
of the ameba. Metchnikoff who had long been study- 
ing these cells was the first to ascertain that they had 



342 SELECTED ADDRESSES 

a special fondness for bacteria which they ingest and 
digest. These cells which include all leukocytic 
groups he called phagocytes. These observations, 
published in 1883/ have been confirmed and extended 
by others and to them is now assigned an important 
role in the resistance and arrest of the pathological 
processes dependent on microbes. In some instances 
the microbe, by exciting inflammation and the massing 
of migrated leukocytes becomes the instrument of its 
own destruction. 

Vaccine Treatment by Opsonins. Among the vac- 
cinations is the treatment of disease by opsonins, 
substances present in both normal and immune serum 
which so act on bacteria as to render them more 
vulnerable to the phagocytic cells. They prepare 
the bacteria to be eaten, whence the word opsonin 
from the Greek, "I provide with food." Their 
affinity for bacteria is specific, that is, the opsonin for 
staphylococcus prepares only staphylococcus to be 
consumed by the phagocytes, the opsonin for tubercle 
bacilli prepares only these bacilli for the phagocytic 
feast and so on. A temperature of 60° C. destroys the 
opsonic property. Sir A. E. Wright called attention 
to these substances in 1903, while somewhat later 
Neufeld and Rimpau in experiments found what was 
evidently the same substance with like properties 
which they called a " bacteriotropic substance" evi- 
dently identical with Wright's opsonin. Hektoen 
has shown that the opsonins are distinct antibodies. 

The treatment is really a revival of that suggested 
by Robert Koch for tuberculosis in 1901, a revival for 
which we are indebted to Wright and his pupils. 
The " opsonic index" is a term used to indicate the 
relative power of phagocytes to engulf and consume 
the microbes of a given disease. It is low when the 

1 Arbeiten des Zoolog. Institutes in Wien, 1883, v., 5. 



REVIEW OF PROGRESS IN MEDICINE 343 

leukocytes possess an abnormally feeble capacity for 
such consumption and high when this capacity is great. 
The treatment consists in the injection of an emulsion 
of specific bacteria (dead cultures), that of the staph- 
ylococcus in acne, furunculosis and abscess; the gono- 
coccus in gonorrhea and the tubercle bacillus in tu- 
berculosis, Wright and his pupils have published 
numerous cases successfully treated by this method, 
including especially those just named. Wright's claims 
have not, however, been altogether sustained by more 
recent observations in this country. The immediate 
object of the treatment is to raise the opsonic index. 
Directions are given for determining the opsonic index, 
a tedious process which need not detain us now. More- 
over, it is really unnecessary to determine the index 
when using the treatment because we can judge of 
improvement as well or better by clinical observation. 
Vaccine Treatment of Typhoid Fever. Up to the 
present time the most important of the various forms 
of vaccine treatment, because of its promising results, 
is the antityphoid vaccination for the purpose of 
securing immunity against this disease. In 1886, 
Frankel and Simmons 1 showed that nonlethal doses 
of living typhoid bacilli protected small animals against 
fatal doses. In 1892, Brieger, Kitasato and Wasser- 
mann 2 showed that dead cultures were equally effica- 
cious and that the immunizing substance lay in the 
bacillus itself. In 1896, Pfeiffer and Kolle 3 im- 
munized two men and showed, as far as laboratories 
permit, the identity of the immunity following an 
attack of the disease and the artificial immunity 

1 Handbuch der Technik und Methodik der Immunitatsforschung 
Vol. I, 423. 

2 Ueber Immunitat und Giftfcstigung, Zcitschr. fur Hygiene, 1S02 
Vol. XII, 137. 

3 Experimentelle Untersuehungen, etc., Dcut. Med. Wochenschr 
1896, 735. 



344 SELECTED ADDRESSES 

produced by inoculation. The British Army, on the 
recommendation of Sir. A. E. Wright, in the Boer war 
of 1897, was the first to use antityphoid vaccination. 
And on the advice of Robert Koch the Germans used 
it in 1904, in their army in Southern West Africa. 
Its use was authorized in the United States Army in 
1909 on the recommendation of a board of medical 
officers, at first only on those volunteering to sub- 
mit. But on the assembly of the maneuver division 
of the U. S. Army on the Mexican border in the spring 
of 1911, all the troops, 12,801, were subjected to the 
inoculation prophylaxis. Only two cases of typhoid 
occurred during the entire period of encampment, 
four months. Of these one of a mild type occurred 
in a private of the hospital corps who had not com- 
pleted his immunization. The other case occurred in 
a civilian teamster not immunized. Although these 
results have been criticised they have been supported 
by such abundant evidence by further use of vaccina- 
tion in our own army that it may be received as an 
accepted fact that typhoid fever can be averted by the 
antityphoid vaccination with as much certainty as 
smallpox can be averted by vaccination by the cowpox. 
The advantages, including economy, of this treatment 
are emphasized when we recall the fact that in the 
short period of the Spanish American War there were 
30,738 cases of typhoid in the army with 1580 deaths 
while 86.24 per cent, of the entire mortality of the 
war was due to this disease. This treatment for 
evident reasons is applicable for the most part only 
where large numbers of individuals are gathered under 
circumstances likely to breed typhoid fever. Such 
are nurses and hospital attendants, interns and even 
practicing physicians in the face of an epidemic. The 
effect is not permanent but experience has shown that 
it may be expected to last three years at least, and 



REVIEW OP PROGRESS IN MEDICINE 345 

the plan at present pursued in our army is to vaccinate 
every three years. The vaccine consisting of killed 
typhoid bacilli is administered hypodermic ally in the 
left arm at the insertion of the deltoid muscle, in 
three doses at intervals of ten days, observing the 
usual antiseptic precautions. The reactive symptoms 
including soreness, headache and sometimes sleep- 
lessness are ordinarily so trifling as to demand no 
attention. 

Especial credit is due Dr. F. F. Russell and Dr. 
A. W. Williams of the U. S. Army upon whom devolved 
most of the work of introducing this form of prophy- 
laxis, with the cooperations of the surgeon general and 
the medical corps generally. The titles of some of 
Dr. Russell's and Dr. Williams' papers are appended 
in the foot note. 1 

The accompanying table furnished me by Dr. 
Russell showing the most recent results of antity- 
phoid prophylaxis tells its own story. 

The ratio for 1912 is based on experience for the 
first half year. Voluntary vaccination began in 1909. 
Compulsory vaccination began in March, 1911, at 
San Antonio, Texas, for Maneuver Division. It 
was made compulsory for all recruits in June, 1911, 
and for the entire army, September 30, 1911. 

Curative Serum Treatment of Typhoid Fever. Chan- 
temesse prepared a curative serum for which he 
claimed encouraging results amounting to a reduction 
of mortality to four per cent, as compared with 

1 Russell : The Prevention of Typhoid Fever by Vaccination and by 
Early Diagnosis and Isolation, Reprint from The Military Surgeon, 
1909; The Prevention and Treatment of Typhoid Fever with Anti- 
typhoid Vaccine, Boston Med. and Surgical Journal, January 5, 1911; 
Results of Antityphoid Vaccination in the Army in 1911, and Its 
Suitability for Use in Civil Communities, Jour. A. M. A., May 4, 
1912. Williams: Vaccination against Typhoid in the U. S. Army. 
Am. Jour. Med. Sci. f March, 1912. 



346 



SELECTED ADDRESSES 



eighteen per cent, in the various hospitals of Paris 
from April, 1901, up to October, 1904. I have not 
been able to find any recent reports on this serum. 





Ratio per Ratio per 


Cases in Deaths in 


Year. 


Cases. 1000 per Deaths. 1000 per 


vaccinated vaccinated 




annum. annum. 


persons. persons. 



1901 


552 


6.74 


72 


0.88 






1902 


565 


6.99 


69 


0.85 






1903 


348 


5.14 


30 


0.44 






1904 


280 


4.77 


20 


0.33 






1905 


193 


3.39 


17 


0.29 






1906 


347 


6.15 


15 


0.26 






1907 


208 


3.87 


16 


0.29 






1908 


239 


3.20 


24 


0.31 







1909 


282 


3.35 


22 


0.26 







1910 


198 


2.43 


14 


0.17 







1911 


68 


0.82 


8 


0.097 


12 


1 


1912 


7 


0.20 


1 


0.003 


3 






In this country William Royal Stokes and John 
S. Fulton following Abel and Loffler experimented with 
a curative serum prepared after the manner of making 
an ti diphtheritic serum and claimed for it also en- 
couraging results. These were published in the 
Maryland Medical Journal, August, 1902, but the 
authors seemed not to have continued their studies. 

Vaccination against Bubonic Plague and Cholera. 
One of the earliest if not the first of the vaccinations 
practiced after that for smallpox was that against 
bubonic plague introduced by Yersin, Calmette and 
Borrell conjointly in 1895. Dead cultures of plague 
bacilli injected subcutaneously into rabbits and 
guinea pigs were found to produce a certain degree of 
immunity against plague. Haffkine extended this 
treatment to man in China and India. Contrasted 
with the prophylactic treatment is Yersin's antipest 
serum and Lustig's serum for curative purposes after 
the manner of diphtheritic antitoxin, and prepared in 



REVIEW OF PROGRESS IN MEDICINE 347 

the same way. A British Indian Commission re- 
ported favorably upon the prophylactic vaccine but a 
divided opinion exists as to the curative serum. The 
commission, however, reported that although the 
method of serum therapy as applied to plague has not 
met with the therapeutic success that attends the 
treatment of diphtheria, nevertheless the method of 
serum therapy is, in plague as in other infectious 
diseases, the only one which offers the prospect of 
success. 

Cholera prophylaxis was similarly secured first by 
Haffkine's efforts and some thousand of possible vic- 
tims have been thus protected, and it may be said of 
cholera, bubonic plague and typhoid fever that vaccine 
injections have been distinctly successful, mortality 
as well as morbility having been diminished. 

Vaccination against Tuberculosis. The treatment 
of tuberculosis by tuberculin in various shapes has 
been less satisfactory than could be desired. Never- 
theless the concensus of opinion at the present day is 
that, with certain exceptions, tuberculin should be 
applied in all cases in which improvement is possible. 
The exceptions are (1) constant headache which awak- 
ens the suspicion that a localization in the central 
nervous system already exists; (2) nephritis, unless 
it be a tuberculous nephritis; (3) diabetes; (4) epilepsy; 
(5) pregnancy. Beginning with Koch's first disap- 
pointing efforts with the original tuberculin in 1900 
several preparations are used, some of which are ex- 
tracts or solutions and some are emulsions. The ex- 
tracts include the filtered unheated culture broth, 
known as Koch's original or old tuberculin (O.T.), 
the watery extracts of von Ruck and Maragliano, and 
Baraneck's tuberculin known as Deny's filtered 
bouillon (B. F.). Deny's tuberculin is said not to 
differ from the original tuberculin of Koch. The 



348 SELECTED ADDRESSES 

emulsions include new tuberculin, tuberculin residue 
(T. R.), the bacillen-emulsion (B. E.) of Koch and 
tulase of von Behring. These last are preparations 
of the pulverized bacilli substance and are classed 
among the vaccines because theoretically they should 
confer more relative immunity than the extracts, but 
their uncertain absorption is a disadvantage. In 
point of fact one can not say from statistics which is 
the better. Antituberculous serum, analagous to 
antidiphtheritic serum, and bacterial vaccine from 
cultures made with sputum according to Sir A. E. 
Wright's method have been used; also antistrepto- 
coccic or streptolytic serum, the last to combat the 
supposed mixed infection. Antituberculous serum 
has been administered by the mouth and rectum. 
Rectal administration is said to be preferable. 

Serum Treatment of Cerebrospinal Meningitis, One 
other application of serum treatment deserves to be 
mentioned, namely that of cerebrospinal meningitis 
by the Flexner serum in which the results appear to be 
second only to those of diphtheria and typhoid fever. 
It is difficult to compare accurately the result of serum 
treatment with those of patients not treated with 
serum in a brief summary because so many conditions 
modify results, such as the age of patients, the stage 
of the disease at which the injection is made, and the 
fluctuation of epidemics; but throwing together all 
groups of cases, nowhere, according to Flexner, was 
the mortality of those not treated by serum less than 
seventy per cent., while in those treated by serum 
nowhere was it more than twenty-five per cent. In- 
deed the latest results fall below fifteen per cent. Dr. 
Flexner is emphatic in requiring the cases to be strictly 
meningococcic, i. e., cases caused by the true meningo- 
coccus and not the diplococcus of pneumonia or tuber- 
cle bacillus both of which produce a form of meningitis. 



REVIEW OF PROGRESS IN MEDICINE 349 

It will be remembered that the injection is made into 
the spinal canal and Dr. Gilman Thompson says it is 
his custom not to wait for the bacteriological report 
but to inject the serum at the same time that the 
tapping of the spinal canal is made, since the beneficial 
effects are directly as the promptness of the injection 
after the clinical diagnosis. It is evident from what 
has been said that the positive diagnosis is possible 
only by the aid of the bacteriological examination. 

Doubtful Results of the Serum Treatment. Passing 
on to the more discouraging aspects of the situation 
we have to acknowledge the complete failure of similar 
efforts in the treatment of the carcinoma by the 
Hodenpyl anticarcinoma serum; of pneumonia by 
pneumococcous vaccines and serum; of colon infection 
by corresponding vaccines; of the doubtful result of 
autoserotherapy and of the treatment of general 
streptococcous and staphylococcous infections and in 
pyemia; also the doubtful result of the Roger-Beebe 
serum in exophthalmic goiter. In bacillary dysentery 
no effect has been noted on the incidence of the disease 
but a great decrease in the mortality of those inocu- 
lated is claimed. In localized staphylococcous infec- 
tion, especially furunculosis, results have been more 
satisfactory than in acne. It will be remembered 
that Wright and his pupils claim good results in cases 
of severe acne, multiple boils, lupus, tuberculous glands 
and bone tuberculosis. Tuberculous glands have 
seemed to respond favorably. Good results are 
claimed for gonococcous vaccines in localized gonor- 
rheal infections, those of the joints especially, in sub- 
acute and chronic cases, while in acute urethritis vac- 
cines have not proved useful and are of doubtful value 
in chronic infections. 

Chemotherapy — Treatment by Salvarsan. No less 
important than the Wassermann test for syphilis is 



350 SELECTED ADDRESSES 

the even more recent treatment of syphilis with 
"salvarsan" or "606" suggested by Ehrlich. Sal- 
varsan is the hydrochlorid of dioxydiamidoarsen- 
benzol. It is a bright yellow powder containing 
theoretically 34.15 per cent of arsenic. It is admin- 
istered subcutaneously, intramuscularly and intra- 
venously in suspension or solution with the addition 
of NaCH to neutralize, thus forming dioxydiamidoar- 
senobenzol + NaCL and H 2 0. Its study, too, is in 
its experimental stage with results which do not reach 
early expectation. 

THE X-RAY 

Perhaps the most brilliant and far reaching addition 
to our medical armamentarium in the last fifty years 
is the x-ray. The germ of the x-ray lay in the peculiar 
luminosity of the vacuum tubes of Geissler (1858-59) 
and of Crookes (1875) when traversed by a discharge 
of electricity. Many of us remember these tubes as 
special novelties in the lectures on electricity to which 
we listened with rapt attention in our school days. 
But in these early experiments neither Geissler (1858- 
59) nor Crookes (1875) produced the x-ray. Their 
tubes were of too low vacuum, though Crookes' were 
much higher than Geissler 's. An important fact in 
this connection, discovered by Bittorf as early as 1860, 
was to the effect that the luminous stream of an elec- 
tric discharge into a Geissler tube could be deflected 
by a magnet. 

Later (1893-94) Crookes, Jackson and Lenard used 
tubes of much higher vacuum. In the course of their 
experiments these observers added many other facts, 
including, by Crookes, the disappearance of the lumi- 
nous glow within the tube as the vacuum is increased 
and the substitution of a scarcely visible rectilinear 



REVIEW OF PROGRESS IN MEDICINE 351 

bundle of rays emanating from the cathode and 
ascribed by Crookes to a projection at great velocity of 
particles of highly attenuated gas or electrified matter. 
This radiation Crookes called cathode rays, better 
named the cathode stream. He found these rays could 
be intercepted by metallic plates within the vacuum 
tube and that their impact against the glass wall of 
the tube produced a greenish phosphorescence and 
fluorescence with high temperature; also that they 
could be deflected by a magnet outside the tube, like 
the luminous stream above referred to. 

In 1891 Hertz found that the cathode rays could 
penetrate gold leaf and other thin sheets of metal 
within the tube. After his death his assistant, Len- 
ard, continued his studies and learned that many of 
the phenomena of the cathode rays could be observed 
outside of the Crookes tube. Experimenting with a 
vacuum tube closed with a tin sheet or window of 
aluminum at the end opposite the cathode, he found 
that the radiation through or from the aluminum wall 
of the tube would pass out into the open air apparently 
through many substances opaque to ordinary light; 
and that after passing through such substances it 
would excite fluorescence in many salts and affect 
sensitive photographic plates just as ordinary light 
does. These phenomena were all ascribed to the 
cathode rays until Rontgen, by the aid of the addi- 
tional facts, cleared up the matter. Among these 
facts were, first, that the #-ray appears to emanate 
only from those parts of the glass of a vacuum tube 
which are rendered fluorescent by the action of the 
cathode rays. Second, that their presence may be 
detected by their effect upon various fluorescent sub- 
stances. Third, that objects placed between a fluor- 
escent screen and the source of the rays may be made 
to cast a shadow upon the screen. Rontgen himself, 



352 SELECTED ADDRESSES 

placing his hands in this position, saw the shadow of 
its bones strongly cast and surrounded by the weaker 
shadow of the flesh; in like manner he produced 
shadow pictures of metallic objects in a wooden box. 
Fourth, that all substances are transparent to this 
radiation though in different degrees, the transmission 
being generally speaking inversely as the density. 
Fifth, that though this radiation passes readily through 
cardboard which is opaque to ordinary light it does not 
produce the sensation of light. In other words the 
x-ray is invisible. Sixth, that it can not be dispersed, 
refracted or reflected to any appreciable extent and 
that it can not be deflected by a magnet. This is in 
contradistinction to Bittorf s discovery already men- 
tioned that the luminous stream of an electric dis- 
charge into a Geissler's tube can be deflected by a mag- 
net and of Crookes' discovery that the same is true of 
the cathodic rays. These results Rontgen communi- 
cated to the Physico-Medical Society of Wurzburg in 
1895. 

The possibilities which lay in these properties were 
evident at once and their application was as prompt as 
their recognition. The announcement spread like 
wildfire and the experiments were repeated with num- 
erous modifications in all parts of the world resulting 
in a confirmation of all that Rontgen claimed. Hav- 
ing become familiar with the above facts the following 
explanation furnished by my friend, Dr. H. K. Pan- 
coast, will be better understood. "The cathode rays, 
or more properly speaking the cathode stream, is 
composed of matter and comprises the negative cor- 
puscles, or the ultimate constituents of all forms of 
matter or all elements. It is through their agency that 
electrical conductivity through gases is accomplished. 
They carry the electrical charge through the x-ray or 
Crookes' tube and their bombardment upon the target 



REVIEW OF PROGRESS IN MEDICINE 353 

of the x-ray tube gives rise to the production of x-rays, 
which are impulses through ether, similar to, but by no 
means identical with, light and heat waves. The 
so-called cathode rays are, therefore, material while 
x-rays are not." 

The essential apparatus for the production of x-rays 
is a vacuum tube highly exhausted and an appliance 
for exciting an electric charge of high potential be- 
tween the ends of the tube. Such may be a static 
machine or an induction apparatus operated from an 
electric light main or the high frequency dr Tesla coil. 
Of these the first only is a primary generator, the others 
being devices for transforming low electric potentials 
into potentials high enough to produce the x-ray in the 
vacuum tube. 

Shadow photographs of objects placed between the 
photographic plate and the vacuum tube may be taken. 
Since the x-ray can not be brought to a focus by means 
of lenses the process is somewhat difficult. The plate 
is wrapped in black paper to keep out ordinary light 
and set up at some distance from the tube and in such 
position that the x-rays emanating from the tube will 
fall on it. The object whose shadow is to be photo- 
graphed is interposed between the plate and the x-rays. 
The picture may be sharpened by a perforated dia- 
phragm of heavy metal placed in front of the tube. 
After a suitable exposure the plate is developed. In 
it, dense areas appear clear while more transparent 
parts are dark. In the printed photograph or skiagraph 
the reverse appears. Photographs thus obtained have 
been variously called skiagraphs, skotographs, radio- 
graphs, shadowgraphs, kathodographs. 

We have seen that certain substances fluoresce when 
the x-ray falls upon them. Such are the double cyanid 
of platinum and barium, of platinum and magnesium, 
of platinum and calcium, the oxid of zinc, the tung- 

23 



354 SELECTED ADDRESSES 

state of calcium and others. If a surface be strewn 
with one of these substances and placed in the path of 
the x-ray it will glow with a pale light as though the 
substance were faintly incandescent. If any object 
be interposed in the path between the vacuum tube 
whence the x-rays emanate and the fluorescent screen it 
will cast a shadow on the screen which differs materially 
from that cast by ordinary light. This is because 
many substances which are opaque to the ordinary 
visual rays are transparent to the x-ray and the reverse. 
It is now recognized that the density of any substance 
to x-rays corresponds practically with the atomic weight 
of its constituent elements. Wood, paper, almost all 
vegetable and animal substances such as wool, leather, 
cotton and silk are transparent to the x-rays. Metals, 
glass containing lead and many mineral substances 
absorb them. Bones also are comparatively opaque. 

The fluoroscope is an instrument based on these 
facts. It consists of a screen or sheet of cardboard 
coated on one side with minute particles of one of the 
substances named, usually the double cyanid of ba- 
rium and platinum or the tungstate of calcium. This 
screen is mounted at one end of a hood of opaque 
material with an opening for the eye of the observer 
at the opposite end. If the fluoroscope is held to the 
eyes with the screen at a distance of twenty to forty 
centimeters from a vacuum tube in which x-rays are 
being generated the surface of the screen is uniformly 
illuminated. 

Now if any object be held between the screen and the 
tube we see the shadow of those portions that are 
opaque to the x-ray. If, for example, a ringed finger 
be held in the paths of the x-rays, the muscular sub- 
stance of the finger will cast a faint shadow, while each 
bony phalanx will stand out distinctly and the ring 
surrounding the finger will be most distinct. In the 



REVIEW OF PROGRESS IN MEDICINE 355 

study of phenomena in living beings the fluoroscope 
sometimes has an advantage over the skiagraph in that 
movements of certain of the organs of the body may be 
recognized and studied while the photograph shows the 
object only at rest at any one stage of such moving 
body. The heart and aorta are especially well studied 
in this way and peristaltic movements of almost the 
entire digestive tract may be observed. 

The X-ray in Diagnosis. The most important early 
application of the x-ray in diagnosis was in the recog- 
nition of fractures and dislocations. Subsequent 
development in the technic has made it the most exact 
and painless method of determining the presence, 
nature and extent of bone and joint injuries, as well as 
an aid to obtaining the best results in the treatment. 
Another early use was the detection of the presence 
and location of foreign bodies. Subsequent develop- 
ments in technic and apparatus have rendered locali- 
zation so exact that even foreign bodies in the orbit 
can be located with absolute precision. 

Along other lines, the scope and accuracy of x-ray 
diagnosis has depended upon the development of 
apparatus, the most important perhaps being those 
improvements in the means of shortening radiographic 
exposure. 

Among the first important applications of x-ray 
diagnosis at the present time may be mentioned the 
following : 

In disease of bones and joints, determining the 
presence, location and extent of lesions, especially 
the earlier stages. 

In connection with the urinary tract, the most im- 
portant application is in the diagnosis of urinary cal- 
culus. In this it has become by far the most exact 
method, with but a small percentage of error, which is 
growing less every day. Changes in position and size 



356 SELECTED ADDRESSES 

of the kidney may be readily shown. Among the later 
possibilities, especially in conjunction with catheter- 
ization of the ureter and injection, are the determina- 
tion of hydronephrosis, pyonephrosis, obstruction of 
the ureter, kinks, etc. 

In dentistry, x-ray diagnosis has a wide field of use- 
fulness in the detection of alveolar abscesses, necrosis, 
impacted and nonerupted teeth, pyorrhea, and other 
conditions. 

In rhinology, it is of great value in the diagnosis of 
sinus disease, and in otology, mastoid disease. 

In the diagnosis of thoracic conditions it has a wide 
field of usefulness, and among its important applica- 
tions may be mentioned the diagnosis of pulmonary 
tuberculosis, especially early lesions, aneurysms and 
dilatations of the aorta, mediastinal growths and glan- 
dular enlargements, pleural and pericardial effusions, 
variations in the size of the heart, etc. 

In the digestive tract, its most important applica- 
tions are in connection with esophageal strictures and 
diverticula, visceroptosis, gastric motility, and ob- 
structions in the large bowel. It is now becoming 
more and more to be relied upon in the diagnosis of 
gastric carcinoma and the determination of the pres- 
ence of adhesions. X-ray students have taught us 
much in connection with the movements and functions 
of the stomach. 

Therapeutic Uses of the X-ray. The first successful 
application of the x-ray in therapeutics was in the 
treatment of lupus vulgaris in which it is almost invari- 
ably effectual. It has now become one of the gen- 
erally recognized therapeutic agents of the dermatolo- 
gist. It has proven a valuable agent, with or without 
surgical or other measures, in the treatment of epi- 
thelioma and carcinoma. In glandular carcinoma it 
has accomplished much good but should never be em- 



REVIEW OF PROGRESS IN MEDICINE 357 

ployed to substitute the prompt use of the knife. 
It is only possibly helpful in the prophylactic treatment 
of the cicatrices after operation. 

It is regarded as an agent of great value in the 
treatment of tuberculous adenitis. In leukemia and 
pseudoleukemia it is practically the only means of 
value we possess in alleviating these diseases, although 
in the former, it has not as yet permanently cured a 
single case. 

RADIUM 

The influence of radium in dissipation of - certain 
morbid growths is undoubted but at this writing is so 
ill-determined that I will not enlarge upon it. Its 
usefulness bids fair to be at least as great as that of the 
#-ray. 

Such are some of the most important advances in 
medicine in the past fifty years, since I entered the 
profession. What is their import? Omitting the 
results of vaccination against smallpox, whose benefi- 
cence had been widely scattered during the half cen- 
tury prior to 1860, but not so effectually as in the last 
half century when it has practically stamped out the 
disease, we have in the evolution of the germ theory 
first the extermination of the silkworm disease, by 
which an industry almost annihilated was revived and 
millions of francs added to the wealth of France and 
Germany as well as remunerative occupation to their 
people. Second, even greater was the saving in the 
elimination of anthrax, a mysterious disease which 
caused the death of thousands of cattle, sheep, horses 
and even human beings in France, Russia and else- 
where ; death succeeding in a few hours with a horrible 
tendency to decomposition. In the province of Nov- 
gorod in Russia 56,000 head of cattle died of the disease 
between 1868 and 1870. 



358 SELECTED ADDRESSES 

Words can not describe the benefit that has been 
derived from antiseptic surgery in innumerable ways, 
including the saving of lives of thousands who without 
it would have perished. 

The mortality of diphtheria has been reduced 
between 50 and 60 per cent.; that of hydrophobia 
from practically 100 to 0.13 per cent.; that of cerebro- 
spinal fever from 70 to 25 per cent.; that of plague 
and cholera has been greatly diminished. It would 
seem that the incidence of typhoid fever can be made 
almost nil, and it would seem also that the most dreaded 
and intractable of all diseases, syphilis, is likely to 
yield to remedies which modern science is bringing 
to bear upon it. 

The x-ray has penetrated the sealed recesses which 
have been so long hiding certain secrets of disease, and 
revealed them one after another in broad relief from 
surrounding media; nay more, has destroyed many of 
them by the same agency which exposed them. 

In the presence of these facts who shall say that the 
science and art of medicine have not progressed in a 
degree reasonably commensurate with other sciences 
and that another half century may not reveal truths 
as startling as those which make the physical world 
to-day a marvel of unexpected developments of man's 
genius. 



XVIII 

L'ENVOI 



XVIII 
L'ENVOI 1 

Mr. Chairman and friends : 

Overwhelmed and bewildered by the evidences of 
affection showered upon me this evening, I scarcely 
know in what vein to respond, whether to laugh or to 
cry. A little of both would perhaps best convey 
my feelings, constituting the effervescence of my grati- 
tude which lies deeper than either. Of one thing there 
can be no doubt, namely, that my reply must in- 
clude something about myself even though it be re- 
garded as scant taste and contrary to Montaigne's 
dictum that one who speaks of himself is apt to do so 
to the detriment of the person spoken of. In this 
respect, however, I do not differ from others who have 
preceded me under like conditions. 

The wherefore of my being with you here in Phila- 
delphia rather than in some other large city is not far 
to seek. Native and to the manor born, I am proud 
to be a Philadelphian and although for a few years 
after my appearance on the stage of life, a nonresi- 
dent, I returned at a comparatively early age to finish 
my school days and prepare for Haverford College 
at which I was entered in 1857 in the sophomore class 
and was graduated in 1860. To my college I owe 
much. Indeed to the training and habit of study there 
acquired I feel I owe largely what I am. Certain it is 
that after such a training I found the course as con- 

1 Remarks at the dinner given Dr. Tyson, May 5, 1910, by his 
friends in the profession on his retirement from the Chair of Medicine. 

361 



362 SELECTED ADDRESSES 

stituted at that day in my medical alma mater, the 
University of Penna., to be very easy of mastery. 

Graduating in Medicine in 1863 I availed myself for 
a few months of the opportunity then everywhere 
offered of service in military hospitals, because of the 
civil war then prevailing, serving in Harrisburg during 
and after the battle of Gettysburg. It was while in 
Harrisburg in July that I was elected resident physi- 
cian at the Pennsylvania Hospital to which I hastened 
to assume my duties. Then followed a period of my 
life which I regard as its happiest. Resident in a 
delightful home, with congenial colleagues, in a hos- 
pital rich in traditions most satisfying to an ambitious 
young graduate, splendid chances to learn, with no 
responsibility except to my chiefs, I was truly con- 
tent and sorry to leave at the end of my altogether 
too short term. 

Beginning private practice in 1864 I again availed 
myself of military hospital appointments and served 
for a short time at Winchester in the valley of Virginia. 
Returning to Philadelphia in the autumn I began at 
once teaching medicine by quizzing students and lec- 
turing on the microscope to private classes, soon 
supplemented by my first appointment in the Univer- 
sity as lecturer on microscopy, and later on urinary 
chemistry and as chief of the medical clinic. I will 
not detain you long with the earlier steps of my career. 
Suffice it that I became one of a group of young 
teachers including Horatio Wood, Edward Rhoads, 
the Peppers, George and William, Harrison Allen and 
later W. W. Keen, Frank Maury and Sam Gross, all 
of whom became prominent. Of these alas there 
remain only my friends Keen and Horatio Wood. 
The newer pathology then coming into notice was one 
of the fields of my interest and in 1870 I was appointed 
pathologist to the Philadelphia Hospital, Blockley, 



L'ENVOI 363 

thus paving the way for my first professorship that of 
general pathology and morbid anatomy in 1876. 
Clinical medicine also assumed larger proportions by 
an appointment as visiting physician to this great 
hospital. Later my transfer to the chair of clinical 
medicine and then to that of theory and practice fur- 
nished the climax of opportunity to meet men as 
teacher and practitioner. To these opportunities were 
added for a number of years those of dean of the Med- 
ical School which brought me into closer intimacy 
with many students. In these relations however I 
was not aggressive, and I cannot be said to have origi- 
nated any policy. I simply did my work as best I 
could, without much thought of approval or dis- 
approval. I was not demonstrative or winning in my 
manners, especially had no personal magnetism. 
On the other hand a certain reserve, born of extreme 
shyness in youth has at times, I fear, been repelling 
rather than winning. Yet gradually I grew into favor, 
I often wondered why. It is true my students of whom 
some 6000 were graduated from the medical school, 
during my connection with it, constitute a small army 
of loyal sons. Yet even these seemed insufficient to 
account for the many evidences of confidence, of 
respect and affection received beyond my deserts. 
Casting about me for further reasons I recognize two 
or three personal qualities which may have found favor 
with those who have been pleased to regard me with 
approval. 

The first of these qualities to which I lay claim is a 
spirit of "fair play," or a " chance for all," irrespective 
of race, or sect, of country or of school. The world 
has always seemed to me big enough for each one who 
desires to work in it and succeed in it without crowding 
out another, and in my relations with professional 
friends I have endeavored to live up to the spirit of this 



364 SELECTED ADDRESSES 

thought, and to extend a welcome to any one who 
might come my way. This I have tried to do in my 
position as a teacher of Medicine, a hospital physician 
and in my relations with the profession as a practi- 
tioner and consultant. In consultations of which I 
have been favored with many from scores of you, while 
seeking to do my best for our patient, I have sought 
also to protect the physician in attendance and secure 
for him as large a share of credit and as little of blame 
as I could, and if I have ever seemed to do else, it has 
been without intention. 

A second attribute to which I lay claim and which 
I think I may say has influenced my conduct of life, 
is a firm belief in eternal justice, by which I mean that 
there will be meted out to each of us somewhere 
between the present and eternity, and I am inclined to 
believe on this side of the dark river, a full measure of 
his deserts, that to every one who seems to have been 
illy requited for his fair play and on whom misfortune 
has seemed to fall too heavily, an equalizing reward 
shall be ultimately awarded, while to him who has 
been unfair and selfish there will come a corresponding 
requital which will make seeming success and apparent 
prosperity a bizarre frame for the dismal picture of self 
and egotism. There is great comfort in such a belief 
and he who accepts it is helped to bear with equanimity 
many trials and disappointments since it places his 
happiness in his own hands. 

As a corollary to this belief is another to the effect 
that it rarely happens that disappointment is not fol- 
lowed sooner or later by some more happy turn of the 
wheel of fortune, in a word that misfortune has become 
good fortune. 

Another quality which may have had to do with such 
success as I have attained is my faith in my profession, 
for I am a firm believer in the profession of medicine, 



L'ENVOI 365 

its aims, its usefulness and the honesty of most of those 
who practice it. I believe it generally conceded that 
none can be more broadening and liberalizing, none 
more humanizing and unselfish. Moreover I cannot 
conceive that any one can practice medicine with the 
proper spirit who does not become a better man for it, 
acquiring higher aims and more generous impulses, 
thus infusing his own character with the virtues 
reflected from his calling. To the majority of prac- 
titioners compensation in money must of necessity be 
small, for the masses among whom most practice can- 
not pay large fees however much they may desire it. 
One cannot get blood out of a stone, and the favored 
few who attend the rich are but a small part of the 
whole number. We must therefore get something 
else out of it. This something is the consciousness of 
" well doing " in a service which counts in its reward not 
only the approval of all mankind but also the develop- 
ment of the higher qualities which distinguish the 
physician as something above the common herd. 
What a privilege to belong to a profession of which 
that masterful genius and life long invalid Robert 
Louis Stevenson wrote the following : 

" There are men and classes of men that stand above 
the common herd : the soldier, the sailor, and the shep- 
herd not infrequently; the artist rarely; rarelier still, 
the clergyman; the physician as a rule. He is the 
flower (such as it is) of our civilization; and when the 
stage of man is done with, and only remembered to be 
marvelled at in history, he will be thought to have 
shared as little as any in the defects of the period, and 
most notably exhibited the virtues of the race. Gen- 
erosity he has such as is possible to those who practice 
an art, never to those who drive a trade; discretion, 
tested by a hundred secrets; tact, tried in a thousand 
embarrassments; and what are more important He- 



366 SELECTED ADDRESSES 

raclean cheerfulness and courage. So it is that he 
brings air and cheer into the sick room, and often 
enough, though not so often as he wishes, brings 
healing." 

I recognize before me many of my former pupils — 
perhaps no living American medical teacher has had 
more — to whom I want to say a word in parting. To 
you more than to any other influence am I indebted 
for whatever success I have attained in our profession. 
You have been my stimulus, my inspiration, my en- 
couragement. Without it my efforts would have been 
feebler and their results flat and unprofitable. 

My cup is full. I cannot say more save only this. 
I know not what there remains to me of life, but while 
it lasts, this night shall be my evening star shining with 
a lustre undimmed by the lapse of time, until drift- 
ing outward with the ebbing tide I shall have crossed 
the bar. 



b§ ni 



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